Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 229171 | MA |
N | 111NI0900X | Internist | 229171 | MA |
Y | 207RA0201X | Internist - Allergy & Immunology | 239932 | MA |
N | 2080P0201X | Pediatric Allergist | 239932 | MA |
NPI | 1518125988 |
---|---|
Provider Name | Dr. Maxim I Lutskiy |
First Address | Boston, MA 02109-4806 |
Second Address | Boston, MA 02215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2008 |
Last Update Date | 04/06/2018 |