Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 262002 | MA |
N | 2084N0402X | Child Neurologist | 262002 | MA |
NPI | 1326480765 |
---|---|
Provider Name | Dr. Lance Harrington Rodan |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115-5724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2013 |
Last Update Date | 14/06/2016 |