Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 227996 | MA |
N | 111NI0900X | Internist | 227996 | MA |
Y | 207RI0200X | Infectious Disease | 227996 | MA |
NPI | 1093762981 |
---|---|
Provider Name | Read Pukkila-Worley |
First Address | Boston, MA 02241-5348 |
Second Address | Worcester, MA 01605-2903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 12/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110081714A | (05) | MA |