Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 284217 | MA |
NPI | 1023074143 |
---|---|
Provider Name | Michael V Boland |
First Address | Boston, MA 02115-6303 |
Second Address | Boston, MA 02115-6303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 06/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I33765 | (02) | MD |