Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 253164 | MA |
Y | 111NI0900X | Internist | 253164 | MA |
NPI | 1003166885 |
---|---|
Provider Name | Ms. Chirin Al Dalati |
First Address | Boston, MA 02215 |
Second Address | Winchester, MA 01890-1446 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2012 |
Last Update Date | 02/04/2018 |