Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 265616 | MA |
NPI | 1013262104 |
---|---|
Provider Name | Dr. Seanna Rae Grob |
First Address | Boston, MA 02114-3002 |
Second Address | Boston, MA 02114-3002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2012 |
Last Update Date | 30/06/2016 |