Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 267401 | MA |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 267401 | MA |
NPI | 1255793907 |
---|---|
Provider Name | Dr. Lara Wahlster |
First Address | Boston, MA 02215-5450 |
Second Address | Boston, MA 02115-5724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2016 |
Last Update Date | 09/09/2019 |