Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 15484 | MA |
Y | 213EG0000X | General Practice | 15484 | MA |
NPI | 1003952508 |
---|---|
Provider Name | Dr. Richard Joseph Luise |
First Address | Wakefield, MA 01880 |
Second Address | Wakefield, MA 01880-2303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 08/07/2007 |