Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 208112 | MA |
N | 2084N0400X | Neurologist | 208112 | MA |
Y | 2084N0402X | Child Neurologist | 208112 | MA |
NPI | 1003970328 |
---|---|
Provider Name | Dr. Maitreyi Mazumdar |
First Address | Cambridge, MA 02139-2301 |
Second Address | Boston, MA 02115-5724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 28/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2117312 | (05) | MA |