Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 216788 | MA |
NPI | 1013064054 |
---|---|
Provider Name | Ingolf Tuerk |
First Address | Brighton, MA 02135-3514 |
Second Address | Brighton, MA 02135-3514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 21/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2107481 | (05) | MA |
I25726 | (02) | MA |