Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 262440 | MA |
NPI | 1023302445 |
---|---|
Provider Name | Dr. Veena Thomas Mathew |
First Address | East Weymouth, MA 02189-3110 |
Second Address | East Weymouth, MA 02189-3110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2011 |
Last Update Date | 20/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023302445 | BLUE CROSS BLUE SHIELD OF MA (01) | MA |
110102840A | (05) | MA |