Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 79266 | MA |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 79266 | MA |
NPI | 1083670228 |
---|---|
Provider Name | Geoffrey J. Van Flandern |
First Address | Chestnut Hill, MA 02467-2503 |
Second Address | Chestnut Hill, MA 02467-2503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 18/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3127524 | (05) | MA |
F79331 | (02) |