Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 44436 | MA |
N | 208600000X | Surgeon | 44436 | MA |
Y | 2086X0206X | Surgical Oncologist | 44436 | MA |
NPI | 1033178066 |
---|---|
Provider Name | Dr. Maureen T Kavanah |
First Address | Boston, MA 02118-2371 |
Second Address | Boston, MA 02118-2905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2006 |
Last Update Date | 30/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110003694A | (05) | MA |