Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 235610 | MA |
N | 207XS0106X | Orthopaedic Hand Surgeon | 235610 | MA |
Y | 2086S0105X | Surgery of the Hand | 235610 | MA |
NPI | 1821124579 |
---|---|
Provider Name | Maximillian C Soong |
First Address | Burlington, MA 01805-0001 |
Second Address | Burlington, MA 01805-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 12/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110080017A | (05) | MA |