Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 279993 | MA |
NPI | 1104389683 |
---|---|
Provider Name | Emily Anderson |
First Address | Boston, MA 02127-2242 |
Second Address | Boston, MA 02111-1552 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2019 |
Last Update Date | 17/06/2019 |