Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 235627 | MA |
NPI | 1003961988 |
---|---|
Provider Name | Lillian Rich |
First Address | Leominster, MA 01453-2205 |
Second Address | Leominster, MA 01453-2205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 09/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000608701 | MEDICARE (01) | MA |
2154072 | (05) | MA |
J43270 | BLUE CROSS/BLUE SHIELD (01) | MA |