Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | 41938 | MA |
NPI | 1306995170 |
---|---|
Provider Name | Luzbella M. Southard |
First Address | Millis, MA 02054-1545 |
Second Address | Millis, MA 02054-1545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0182842 | (05) | MA |
6274 | HARVARD PILGRIM HEALTHCAR (01) | MA |
738314 | TUFTS HEALTH CARE (01) | MA |
D88206 | (02) | MA |