Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 240274 | MA |
Y | 2080P0214X | Pediatric Pulmonologist | 240274 | MA |
NPI | 1487844403 |
---|---|
Provider Name | Jonathan M Gaffin |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115-5724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2007 |
Last Update Date | 26/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
231380 | MASSACHUSETTS (01) | MA |