Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 158930 | MA |
N | 207VG0400X | Gynecologist | 158930 | MA |
NPI | 1134108590 |
---|---|
Provider Name | Natasha R. Johnson |
First Address | Brookline, MA 02445-6002 |
Second Address | Boston, MA 02115-6110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 23/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3199835 | (05) | MA |