Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 12155-1 | MA |
NPI | 1023294741 |
---|---|
Provider Name | Dr. Patricia L. Brown |
First Address | Boston, MA 02215-2823 |
Second Address | Boston, MA 02215-2823 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2008 |
Last Update Date | 11/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0264229 | (05) | MA |