Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 30811 | MA |
N | 2084N0400X | Neurologist | 30811 | MA |
Y | 2084N0402X | Child Neurologist | 30811 | MA |
NPI | 1396737714 |
---|---|
Provider Name | Paul N Chervin |
First Address | Woburn, MA 01801 |
Second Address | Woburn, MA 01801-2982 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2005 |
Last Update Date | 04/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0115142 | (05) | MA |
11326 | HPIP (01) | MA |
701626 | TUFTS (01) | MA |
A65868 | (02) |