Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 48677 | MA |
NPI | 1023349107 |
---|---|
Provider Name | Dr. Ronald David Coulombe |
First Address | Somerset, MA 02725-2843 |
Second Address | Somerset, MA 02725-2843 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2010 |
Last Update Date | 29/01/2010 |