Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 227605 | MA |
Y | 2080P0203X | Pediatric Critical Care Doctor | 227605 | MA |
NPI | 1114951878 |
---|---|
Provider Name | Meredith Giglia Van Der Velden |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 26/08/2015 |