Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | PA5253 | MA |
Y | 208600000X | Surgeon | PA5253 | MA |
NPI | 1003209883 |
---|---|
Provider Name | Ms. Kendra Read |
First Address | Cambridge, MA 02138-5502 |
Second Address | Brookline, MA 02445-6776 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2015 |
Last Update Date | 11/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11012214A | (05) | MA |