Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 243244 | MA |
NPI | 1003052788 |
---|---|
Provider Name | Dr. Stephen D Anesi |
First Address | Waltham, MA 02451 |
Second Address | Waltham, MA 02451 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2008 |
Last Update Date | 18/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110090936A | (05) | MA |