Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 77958 | MA |
NPI | 1013006261 |
---|---|
Provider Name | Dr. Valia A Boosalis |
First Address | Boston, MA 02130-4817 |
Second Address | Boston, MA 02130-4817 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 01/08/2007 |