Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 31591 | MA |
N | 207RP1001X | Pulmonary Disease | 31591 | MA |
NPI | 1144324716 |
---|---|
Provider Name | Dr. Robert K Gedachian |
First Address | Worcester, MA 01608-1220 |
Second Address | Worcester, MA 01608-1220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2006 |
Last Update Date | 22/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0197203 | (05) | MA |
A67106 | (02) | MA |
A67106 | (02) | NH |