Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 35.056367 | OH |
NPI | 1326676198 |
---|---|
Provider Name | Niranjan Kanesa-Thasan |
First Address | Lexington, MA 02420-1853 |
Second Address | Lexington, MA 02420-1853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2020 |
Last Update Date | 29/03/2020 |