Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 31138 | MA |
NPI | 1083723324 |
---|---|
Provider Name | John L Ohman |
First Address | Southborough, MA 01772 |
Second Address | Boston, MA 02111-1526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 07/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2015528 | (05) | MA |
C46279 | (02) | MA |