Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 34636 | MA |
NPI | 1053321844 |
---|---|
Provider Name | Dr. Neil B. Ruderman |
First Address | Boston, MA 02118 |
Second Address | Boston, MA 02118-2309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 04/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110036320A | (05) | MA |