Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 52333 | MA |
NPI | 1700941143 |
---|---|
Provider Name | Robert Chernack |
First Address | Boston, MA 02109-4806 |
Second Address | Somerville, MA 02144-2705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2006 |
Last Update Date | 08/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0014437 | NHP (01) | MA |
052333 | TUFTS (01) | MA |
3178854 | (05) | MA |
6239385-002 | CIGNA (01) | MA |
F04484 | (02) | MA |
J11781 | BCBS (01) | MA |
PB222 | HPHC (01) | MA |