Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 287545 | MA |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | T287545 | MA |
NPI | 1386094795 |
---|---|
Provider Name | Michelle Mo |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115-5724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2016 |
Last Update Date | 19/07/2021 |