Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 036086905 | IL |
NPI | 1003852526 |
---|---|
Provider Name | Nancy Gracin |
First Address | Waltham, MA 02451 |
Second Address | Waltham, MA 02451-1132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 10/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F68295 | (02) |