Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080A0000X | Adolescent Medicine | 44627 | MA |
N | 2080P0205X | Pediatric Endocrinologist | 44627 | MA |
NPI | 1023054251 |
---|---|
Provider Name | Dr. Marion Joan Mansfield |
First Address | Lincoln, MA 01773-3204 |
Second Address | Boston, MA 02215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6165508 | (05) | MA |
E05973 | (02) | MA |