Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 25MA10789900 | NJ |
NPI | 1013396449 |
---|---|
Provider Name | Priya Patidar |
First Address | Waltham, MA 02451-0866 |
Second Address | New York, NY 10016-6402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2015 |
Last Update Date | 26/07/2021 |