Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0600003291 | VT |
Y | 2080P0214X | Pediatric Pulmonologist | 235030 | MA |
NPI | 1366575037 |
---|---|
Provider Name | Mrs. Alicia M.h. Casey |
First Address | West Roxbury, MA 02132-5126 |
Second Address | Boston, MA 02115-5724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 27/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RES000 | (02) | VT |