Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 265963 | MA |
N | 2080P0204X | Pediatric Emergency Doctor | 265963 | MA |
NPI | 1073889333 |
---|---|
Provider Name | Kelsey Ann Miller |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115-5724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2012 |
Last Update Date | 15/01/2019 |