Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | L-241414 | MA |
N | 111NI0900X | Internist | L-241414 | MA |
Y | 207RN0300X | Nephrologist | 249274 | MA |
NPI | 1003043571 |
---|---|
Provider Name | Meghan E Sise |
First Address | Boston, MA 02114-2783 |
Second Address | Boston, MA 02114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2009 |
Last Update Date | 12/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S400205948 | MEDICARE PROVIDER (01) | MA |