Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | ML20008564 | WA |
N | 208600000X | Surgeon | ML20008564 | WA |
N | 2086S0102X | Surgical Critical Care | 246710 | MA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | Q2768 | TX |
NPI | 1316056245 |
---|---|
Provider Name | Jonathan Seth Friedstat |
First Address | Boston, MA 02114-2696 |
Second Address | Boston, MA 02114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 09/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
347245801 (MDACC) | (05) | TX |