Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 2148 | MA |
Y | 222Z00000X | Podiatrist | 2148 | MA |
NPI | 1003822529 |
---|---|
Provider Name | Joyce R Child |
First Address | East Bridgewater, MA 02333-1148 |
Second Address | East Bridgewater, MA 02333-1465 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 10/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3021319 | (05) | MA |
LX5194 | MEDICARE PTAN (01) | MA |
U82506 | (02) |