Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 203754 | MA |
N | 207RX0202X | Medical Oncology | 203754 | MA |
NPI | 1083696298 |
---|---|
Provider Name | Dr. Wolfram Goessling |
First Address | Boston, MA 02215-5418 |
Second Address | Boston, MA 02114-2696 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2005 |
Last Update Date | 18/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110005349A | (05) | MA |
203754 | TUFTS HEALTH PLAN (01) | MA |
H60404 | (02) | |
J24568 | BCBS MA (01) | MA |