Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 230098 | MA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 230098 | MA |
NPI | 1245228436 |
---|---|
Provider Name | George Maxted |
First Address | Fall River, MA 02720-6009 |
Second Address | Fall River, MA 02720-6009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1300709 | (05) | MA |
45759 | BMC (01) | MA |
H43729 | (02) | |
H43729 | (02) | MA |