Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 36140 | MA |
NPI | 1003892803 |
---|---|
Provider Name | Jeffrey Mark Drazen |
First Address | Boston, MA 02118-4001 |
Second Address | Boston, MA 02118-2526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2005 |
Last Update Date | 31/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2054787 | (05) | MA |
B76495 | (02) | MA |