Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 289703 | MA |
NPI | 1104406834 |
---|---|
Provider Name | John Spencer Herendeen |
First Address | Boston, MA 02111-1552 |
Second Address | Boston, MA 02111-1552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2021 |
Last Update Date | 21/06/2021 |