Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 81511 | MA |
Y | 208600000X | Surgeon | 81511 | MA |
N | 2082S0105X | Plastic Hand Surgeon | 81511 | MA |
NPI | 1467546804 |
---|---|
Provider Name | Marc Charles Fater |
First Address | Hyannis, MA 02601-3109 |
Second Address | Hyannis, MA 02601-3109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 01/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G10514 | (02) | MA |