Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 1089 | MA |
NPI | 1003826827 |
---|---|
Provider Name | Dr. Philip Barron |
First Address | Mattapan, MA 02126-1747 |
Second Address | Mattapan, MA 02126-1747 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1612522 | (05) | MA |
T58386 | (02) | MA |