Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 238560 | MA |
NPI | 1073581898 |
---|---|
Provider Name | Gregory G Smaroff |
First Address | Burlington, MA 01805-0001 |
Second Address | Burlington, MA 01805-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 17/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110082075A | (05) | MA |
I28667 | (02) |