Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 228725 | MA |
Y | 111NI0900X | Internist | 228725 | MA |
NPI | 1003075276 |
---|---|
Provider Name | Laura Ferreira Provenzano |
First Address | Boston, MA 02135-2907 |
Second Address | Boston, MA 02135-2907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2008 |
Last Update Date | 03/06/2008 |