Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 223013 | MA |
NPI | 1013943679 |
---|---|
Provider Name | Laurence H Brinckerhoff |
First Address | Boston, MA 02111-1552 |
Second Address | Boston, MA 02111-1526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 08/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I16670 | (02) |