Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 59526 | MA |
NPI | 1003834920 |
---|---|
Provider Name | Grace Makari-Judson |
First Address | Springfield, MA 01199-1001 |
Second Address | Springfield, MA 01107-1112 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 02/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D82928 | (02) | MA |