Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 44319 | MA |
NPI | 1043208192 |
---|---|
Provider Name | Dr. Martin David Broff |
First Address | South Weymouth, MA 02190-1612 |
Second Address | South Weymouth, MA 02190-1612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
044319 | TUFTS HEALTH CARE (01) | MA |
1005 | HARVARD PILGRIM (01) | MA |
2088649 | (05) | MA |
A53963 | (02) | |
C27088 | BLUE CROSS BLUE SHIELD (01) | MA |