Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 73773 | MA |
NPI | 1629048665 |
---|---|
Provider Name | Dr. Peter Rosenblatt |
First Address | Cambridge, MA 02138-5502 |
Second Address | Cambridge, MA 02138-1040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 25/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3141781 | (05) | MA |
F89755 | (02) | MA |