Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 32515 | MA |
NPI | 1033181698 |
---|---|
Provider Name | Michael V Ditullio |
First Address | Weymouth, MA 02190-1622 |
Second Address | Weymouth, MA 02190-1622 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B98857 | (02) | MA |