Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 25012 | MA |
N | 208600000X | Surgeon | 25012 | MA |
Y | 2086S0120X | Pediatric Surgery | 25012 | MA |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 25012 | MA |
NPI | 1487673976 |
---|---|
Provider Name | Dr. William Hardy Hendren III |
First Address | Boston, MA 02115-3912 |
Second Address | Boston, MA 02115-3912 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 14/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
138894 | (05) | MA |
C57276 | (02) |