Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 252843 | MA |
N | 111NI0900X | Internist | 252843 | MA |
Y | 207RI0200X | Infectious Disease | 266559 | MA |
NPI | 1083976807 |
---|---|
Provider Name | Mr. Conor Mccolgan Stack |
First Address | Boston, MA 02215-5400 |
Second Address | Boston, MA 02215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2012 |
Last Update Date | 15/08/2018 |