Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 160307 | MA |
NPI | 1063482842 |
---|---|
Provider Name | John Vidrih |
First Address | Weymouth, MA 02190-2432 |
Second Address | Weymouth, MA 02190-2432 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H05974 | (02) | MA |