Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DF11489 | MA |
NPI | 1548662224 |
---|---|
Provider Name | Dr. Reshma Menon |
First Address | Boston, MA 02115 |
Second Address | Boston, MA 02115-9998 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2014 |
Last Update Date | 27/03/2020 |