Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 150326 | MA |
NPI | 1043243975 |
---|---|
Provider Name | Randi Ellen Berkowitz |
First Address | Newton, MA 02459-1709 |
Second Address | Roslindale, MA 02131-1011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G91138 | (02) | MA |