Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 248396 | MA |
N | 111NI0900X | Internist | 248396 | MA |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 268772 | MA |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 9382023-1204 | UT |
Y | 2081S0010X | Sports Medicine | 268772 | MA |
Y | 213ES0000X | Sports Medicine | 268772 | MA |
NPI | 1265720858 |
---|---|
Provider Name | Dr. Steven Makovitch |
First Address | Newton, MA 02459-3301 |
Second Address | Newton, MA 02459-3301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2011 |
Last Update Date | 03/02/2017 |