Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | NA | MA |
Y | 222Z00000X | Podiatrist | NA | MA |
NPI | 1023672979 |
---|---|
Provider Name | Lowell Tong |
First Address | Boston, MA 02215-5324 |
Second Address | Boston, MA 02215-5324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2019 |
Last Update Date | 25/04/2019 |