Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 237362 | MA |
Y | 2084N0600X | Clinical Neurophysiologist | 237362 | MA |
NPI | 1043486632 |
---|---|
Provider Name | Ritu Bagla |
First Address | Burlington, MA 01805-0001 |
Second Address | Burlington, MA 01805-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2008 |
Last Update Date | 03/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2159902 | (05) | MA |