Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 225840 | MA |
N | 207RC0200X | Critical Care Medicine | 225840 | MA |
NPI | 1063402535 |
---|---|
Provider Name | Dr. Roland R Brusseau |
First Address | Boston, MA 02115 |
Second Address | Boston, MA 02115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 20/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
478748 | TUFTS HEALTH PLAN (01) | MA |
J29254 | BCBS OF MA (01) | MA |