Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 204384 | MA |
NPI | 1003850306 |
---|---|
Provider Name | Lori F Vazzana |
First Address | Brockton, MA 02302-3308 |
Second Address | Brockton, MA 02302-3308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1200283 | (05) | MA |
G96547 | (02) | MA |