Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 246322 | MA |
N | 207R00000X | Internist | 267895 | MA |
N | 111NI0900X | Internist | 267895 | MA |
NPI | 1013368265 |
---|---|
Provider Name | Jacqueline Boehme |
First Address | Boston, MA 02115-6110 |
Second Address | Boston, MA 02115-6110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2016 |
Last Update Date | 18/05/2020 |