Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 47653 | MA |
NPI | 1255320966 |
---|---|
Provider Name | Robert Ernst Miegel |
First Address | Brighton, MA 02135-2065 |
Second Address | Cambridge, MA 02138-5600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2005 |
Last Update Date | 07/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0161454 | (05) | MA |
A66493 | (02) |