Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 208361 | MA |
NPI | 1720090228 |
---|---|
Provider Name | Ellen H Zhan |
First Address | Brookline, MA 02467-2674 |
Second Address | West Roxbury, MA 02132-4927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 13/08/2012 |