Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | A61361 | CA |
N | 208000000X | Pediatrician | MD00045538 | WA |
N | 2080P0202X | Pediatric Cardiologist | 245758 | MA |
N | 2080P0202X | Pediatric Cardiologist | MD00045538 | WA |
NPI | 1023037611 |
---|---|
Provider Name | Michelle Z Gurvitz |
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 | 18/07/2006 |
Last Update Date | 02/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A613610 | MEDICAL PPIN # (01) | CA |
8436511 | (05) | WA |
H85414 | (02) | CA |