Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 157045 | MA |
NPI | 1013990647 |
---|---|
Provider Name | Dr. Patrick T Ellinor |
First Address | Charlestown, MA 02129-9142 |
Second Address | Boston, MA 02114-2621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2005 |
Last Update Date | 15/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3200566 | (05) | MA |
405901 | TUFTS HEALTH PLAN (01) | MA |
H03941 | (02) | |
J21743 | BCBS MA (01) | MA |