Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 77417 | MA |
NPI | 1922099027 |
---|---|
Provider Name | Dr. Richard E. Gliklich |
First Address | Boston, MA 02114-3002 |
Second Address | Boston, MA 02114-3002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 06/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3107493 | (05) | MA |
F53050 | (02) | MA |