Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 071016 | MA |
NPI | 1326002817 |
---|---|
Provider Name | Gregory Goodwin |
First Address | Somerset, MA 02726-4043 |
Second Address | Boston, MA 02115-5711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 04/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7007517 | (05) | MA |
H07611 | (02) | MA |