Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 1933 | MA |
N | 222Z00000X | Podiatrist | 1933 | MA |
Y | 213EP1101X | Primary Podiatric Medicine | 1933 | MA |
NPI | 1053429928 |
---|---|
Provider Name | Dr. Robert C. Crago |
First Address | Wrentham, MA 02093-1450 |
Second Address | West Roxbury, MA 02132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 31/07/2018 |