Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 242212 | MA |
NPI | 1023218237 |
---|---|
Provider Name | Joshua Shofner |
First Address | Somerville, MA 02143-2023 |
Second Address | Winchester, MA 01890-1992 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2007 |
Last Update Date | 12/06/2012 |