Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 159754 | MA |
Y | 2080P0205X | Pediatric Endocrinologist | 159754 | MA |
NPI | 1043291107 |
---|---|
Provider Name | Dr. Madhusmita Misra |
First Address | Charlestown, MA 02129-9142 |
Second Address | Boston, MA 02114-2621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2005 |
Last Update Date | 26/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0193089 | (05) | MA |
159754 | TUFTS HEALTH PLAN (01) | MA |
1879701 001 | CIGNA PAL (01) | |
204420 | HPHC PBO (01) | |
7285372 | AETNA (01) | |
H59967 | (02) | |
J24751 | BCBS MA (01) | MA |