Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 41347 | MA |
N | 111NI0900X | Internist | 41347 | MA |
N | 207RH0003X | Hematology & Oncology | 41347 | MA |
Y | 207RX0202X | Medical Oncology | 41347 | MA |
NPI | 1093796419 |
---|---|
Provider Name | Dr. Ronald Wayne Takvorian |
First Address | Charlestown, MA 02129-9142 |
Second Address | Boston, MA 02114-2621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2005 |
Last Update Date | 24/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0115363 | (05) | MA |
729753 | TUFTS HEALTH PLAN (01) | MA |
A54660 | (02) | |
E05323 | BCBS MA (01) | MA |