Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0204X | Pediatric Emergency Doctor | 002206 | NY |
Y | 2080P0204X | Pediatric Emergency Doctor | 281998 | MA |
NPI | 1215996061 |
---|---|
Provider Name | Dr. Martin Victor Pusic |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115-5724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 21/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02098488 | (05) | NY |
F94226 | (02) | NY |