Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 49004 | MA |
NPI | 1114086360 |
---|---|
Provider Name | Paul Romain |
First Address | Cambridge, MA 02139-1047 |
Second Address | Cambridge, MA 02139-1047 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C09534 | (02) | MA |