Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 042.0012780 | VT |
Y | 208200000X | Surgeon | 219964 | MA |
Y | 208600000X | Surgeon | 219964 | MA |
NPI | 1366412017 |
---|---|
Provider Name | Dr. Martin Hertl |
First Address | Charleston, MA 02129-9142 |
Second Address | Boston, MA 02114-2621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 29/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2037840 | (05) | MA |
468642 | TUFTS HEALTH PLAN (01) | MA |
I01118 | (02) | |
J27207 | BCBS MA (01) | MA |