Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 247645 | MA |
NPI | 1609162783 |
---|---|
Provider Name | Kim Elizabeth Tripp |
First Address | Pittsfield, MA 01201-4109 |
Second Address | Pittsfield, MA 01201-4109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2011 |
Last Update Date | 27/06/2011 |