Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 81274 | MA |
N | 208600000X | Surgeon | 81274 | MA |
N | 2082S0105X | Plastic Hand Surgeon | 81274 | MA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 81274 | MA |
NPI | 1811995806 |
---|---|
Provider Name | Eleanor C Pitts |
First Address | Worcester, MA 01608-1604 |
Second Address | Boston, MA 02130-3446 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 04/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3145387 | (05) | MA |
E89925 | (02) |