Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 279836 | MA |
N | 207PE0004X | Emergency Medical Services | 279836 | MA |
NPI | 1154732352 |
---|---|
Provider Name | Erin M. Ciummo |
First Address | Boston, MA 02241-5348 |
Second Address | Worcester, MA 01655-0002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2014 |
Last Update Date | 12/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110135936A | (05) | MA |