Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 11117 | MA |
NPI | 1134115132 |
---|---|
Provider Name | Dr. Steven A Wolman |
First Address | Longmeadow, MA 01106-1642 |
Second Address | Longmeadow, MA 01106-1642 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2005 |
Last Update Date | 04/03/2013 |