Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 282073 | MA |
NPI | 1003465386 |
---|---|
Provider Name | Dr. Philipp Johann Fassbender |
First Address | Boston, MA 02215 |
Second Address | Boston, MA 02215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2019 |
Last Update Date | 11/09/2021 |