Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 221748 | MA |
NPI | 1174745103 |
---|---|
Provider Name | Rebecca Anne Miksad |
First Address | Boston, MA 02119-2560 |
Second Address | Boston, MA 02118-2905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 23/10/2019 |