Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 112429 | PA |
Y | 2080P0205X | Pediatric Endocrinologist | 278122 | MA |
NPI | 1386902724 |
---|---|
Provider Name | Marissa Blair Avolio |
First Address | Boston, MA 02111-1552 |
Second Address | Boston, MA 02111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2012 |
Last Update Date | 09/08/2019 |