Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 243921 | MA |
N | 208600000X | Surgeon | 243921 | MA |
Y | 2086X0206X | Surgical Oncologist | 243921 | MA |
NPI | 1114186905 |
---|---|
Provider Name | Dr. Michael Ryan Cassidy |
First Address | Boston, MA 02118-2308 |
Second Address | Boston, MA 02118-2308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2008 |
Last Update Date | 17/02/2017 |