Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 56421 | MA |
Y | 2080P0214X | Pediatric Pulmonologist | 56421 | MA |
NPI | 1497845762 |
---|---|
Provider Name | Dr. Thomas R Martin |
First Address | Auburndale, MA 02466-1610 |
Second Address | Boston, MA 02115-5724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2006 |
Last Update Date | 14/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3010724 | (05) | MA |
E01872 | (02) |