Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | 42799 | MA |
NPI | 1124012299 |
---|---|
Provider Name | Leslie A Martin |
First Address | Brighton, MA 02135 |
Second Address | Brighton, MA 02135-2907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2005 |
Last Update Date | 17/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0195774 | (05) | MA |
B73286 | (02) |