Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 266751 | MA |
N | 2080P0203X | Pediatric Critical Care Doctor | 266751 | MA |
NPI | 1124360003 |
---|---|
Provider Name | Nathaniel Kenneth Mosley |
First Address | Boston, MA 02114-2621 |
Second Address | Boston, MA 02114-2621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2013 |
Last Update Date | 02/05/2017 |