Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 286311 | MA |
Y | 111NI0900X | Internist | 286311 | MA |
NPI | 1003300765 |
---|---|
Provider Name | Julia Marie Berg |
First Address | Boston, MA 02215-5400 |
Second Address | Boston, MA 02215-5400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2018 |
Last Update Date | 12/10/2021 |