Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 248717-1 | NY |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 273202 | MA |
N | 208G00000X | Cardiothoracic Vascular Surgeon | A69615 | CA |
NPI | 1083800585 |
---|---|
Provider Name | Dr. Leora Beth Balsam |
First Address | Boston, MA 02241-5348 |
Second Address | Worcester, MA 01655-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2007 |
Last Update Date | 02/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A869820 | (05) | CA |
113678 | (02) | CA |