Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 42857 | MA |
N | 208000000X | Pediatrician | 42857 | MA |
N | 2080P0203X | Pediatric Critical Care Doctor | 42857 | MA |
NPI | 1578544557 |
---|---|
Provider Name | Dr. Patricia Jean Omalley |
First Address | Charlestown, MA 02129-9142 |
Second Address | Boston, MA 02114-2696 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0128082 | (05) | MA |
042857 | TUFTS HEALTH PLAN (01) | MA |
D88921 | (02) | |
N01890 | BCBS MA (01) | MA |