Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 262390 | MA |
N | 111NI0900X | Internist | 262390 | MA |
Y | 207SG0201X | Clinical Genetics (M.D.) | 262390 | MA |
NPI | 1639433220 |
---|---|
Provider Name | Mersedeh Rohanizadegan |
First Address | Boston, MA 02115 |
Second Address | Boston, MA 02115 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2012 |
Last Update Date | 18/06/2018 |