Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 55857 | MA |
N | 207PE0004X | Emergency Medical Services | 55857 | MA |
NPI | 1104801778 |
---|---|
Provider Name | Marc C. Restuccia |
First Address | Sterling, MA 01564-2005 |
Second Address | Worcester, MA 01655-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 27/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110049857A | (05) | MA |
E84979 | (02) | MA |