Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 256291 | MA |
N | 111NI0900X | Internist | 256291 | MA |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 256291 | MA |
NPI | 1033558093 |
---|---|
Provider Name | Marisa Flavin |
First Address | Aurora, CO 80045-2570 |
Second Address | Boston, MA 02129-3109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2013 |
Last Update Date | 27/10/2021 |