Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 150595 | MA |
Y | 208600000X | Surgeon | 150595 | MA |
NPI | 1023084167 |
---|---|
Provider Name | Nr Chandrasekar |
First Address | Canton, MA 02021-1367 |
Second Address | Canton, MA 02021-1367 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 16/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3178579 | (05) | MA |
G33672 | (02) | MA |