Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | PA6591 | MA |
NPI | 1316421852 |
---|---|
Provider Name | Ms. Emma Peditto |
First Address | Boston, MA 02215-5566 |
Second Address | Boston, MA 02215-5566 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2018 |
Last Update Date | 20/09/2018 |