Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 250205 | MA |
Y | 207Q00000X | Family Doctor | 250205 | MA |
NPI | 1558597096 |
---|---|
Provider Name | Dr. Larissa Ann Calka Gemme |
First Address | Beverly, MA 01915 |
Second Address | Beverly, MA 01915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2009 |
Last Update Date | 25/11/2013 |