Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 735510 | MA |
N | 111NI0900X | Internist | 735510 | MA |
Y | 213EP1101X | Primary Podiatric Medicine | 1793 | MA |
NPI | 1043208242 |
---|---|
Provider Name | Edward J Mostone |
First Address | Medford, MA 02155-3337 |
Second Address | Medford, MA 02155 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 24/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0362263 | (05) | MA |
T31803 | (02) | MA |