Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 79297 | MA |
NPI | 1164598801 |
---|---|
Provider Name | Mr. James Vincent Bono |
First Address | Boston, MA 02120 |
Second Address | Boston, MA 02120 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2006 |
Last Update Date | 04/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
171504 | HARVARD PILGRIM (01) | |
733745 | TUFTS HEALTH PLAN (01) | |
F77050 | (02) |