Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 150940 | MA |
NPI | 1639171101 |
---|---|
Provider Name | George H Theodore |
First Address | Hingham, MA 02043-0086 |
Second Address | Boston, MA 02114-2743 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2005 |
Last Update Date | 27/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3152502 | (05) | MA |
G26707 | (02) | MA |