Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 263545 | MA |
Y | 207VG0400X | Gynecologist | 278055 | MA |
NPI | 1063807600 |
---|---|
Provider Name | Nidha P. Mattappally |
First Address | Burlington, MA 01805-0001 |
Second Address | Burlington, MA 01805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2015 |
Last Update Date | 24/05/2019 |