Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 154977 | MA |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 2005-0084 | NM |
N | 207YS0123X | Facial Plastic Surgeon | 154977 | MA |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 154977 | MA |
N | 208200000X | Surgeon | 154977 | MA |
N | 208600000X | Surgeon | 154977 | MA |
NPI | 1760497226 |
---|---|
Provider Name | Edwin Ishoo |
First Address | Waltham, MA 02452-6329 |
Second Address | Brookline, MA 02445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2006 |
Last Update Date | 23/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2161133 | (05) | MA |
A2852201 | (02) | MA |
G72583 | (02) | NM |