Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 52300 | MA |
Y | 2080P0205X | Pediatric Endocrinologist | 52300 | MA |
NPI | 1477530939 |
---|---|
Provider Name | Dr. Paul Alfred Boepple |
First Address | Charlestown, MA 02129-9142 |
Second Address | Boston, MA 02114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2005 |
Last Update Date | 30/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6186734 | (05) | MA |
724780 | TUFTS HEALTH PLAN (01) | MA |
D88380 | (02) | |
J04164 | BCBS MA (01) | MA |