Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 1206 | MA |
N | 208000000X | Pediatrician | 28697 | MA |
NPI | 1063486454 |
---|---|
Provider Name | Dr. Lewis Ball Holmes |
First Address | Charlestown, MA 02129-9142 |
Second Address | Boston, MA 02114-2696 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 20/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2022745 | (05) | MA |
724452 | TUFTS HEALTH PLAN (01) | MA |
E03264 | (02) | |
M07471 | BCBS MA (01) | MA |