Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 245780 | MA |
N | 111NI0900X | Internist | 245780 | MA |
Y | 207RH0003X | Hematology & Oncology | 245780 | MA |
NPI | 1063567451 |
---|---|
Provider Name | Jonathan Carlson |
First Address | Boston, MA 02114-2621 |
Second Address | Boston, MA 02114-2621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 10/04/2013 |