Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 16237 | MA |
NPI | 1235282419 |
---|---|
Provider Name | Mr. Nick George Georges |
First Address | Danvers, MA 01923-3675 |
Second Address | Danvers, MA 01923-3675 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
363354 | BLUE CROSS BLUE SHIELD (01) | MA |
703485 | HARVARD PILGRIM (01) | MA |