Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 204195 | MA |
NPI | 1043302623 |
---|---|
Provider Name | Gary James Pare |
First Address | Methuen, MA 01844-5870 |
Second Address | Methuen, MA 01844-5870 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 09/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110007031A | (05) | MA |
J24933 | BLUE SHIELD (01) | MA |