Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | L-251548 | MA |
N | 208600000X | Surgeon | L-251548 | MA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 32210 | MN |
NPI | 1073873022 |
---|---|
Provider Name | Jarrod D. Predina |
First Address | Boston, MA 02114 |
Second Address | Boston, MA 02114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2012 |
Last Update Date | 22/09/2021 |