Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 11365 | MA |
NPI | 1043245269 |
---|---|
Provider Name | Dr. Michael A Blau |
First Address | Cambridge, MA 02140-2218 |
Second Address | Cambridge, MA 02140-2218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 08/07/2007 |