Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 42482 | MA |
N | 208600000X | Surgeon | 42482 | MA |
N | 2086S0102X | Surgical Critical Care | 42482 | MA |
Y | 2086S0120X | Pediatric Surgery | 42482 | MA |
NPI | 1043239536 |
---|---|
Provider Name | Dr. Robert Cooper Shamberger |
First Address | Boston, MA 02115 |
Second Address | Boston, MA 02115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 20/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A54900 | (02) |