Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 212596 | MA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 212596 | MA |
NPI | 1194705616 |
---|---|
Provider Name | Dr. Robert Joseph Nicoletta JR. |
First Address | Boston, MA 02118-2371 |
Second Address | Boston, MA 02118-2526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 21/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110073470A | (05) | MA |