Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | L-263834 | MA |
NPI | 1003297516 |
---|---|
Provider Name | Kendrick M Shaw |
First Address | Boston, MA 02114 |
Second Address | Boston, MA 02114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2015 |
Last Update Date | 11/06/2015 |