Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 59625 | MA |
NPI | 1235193889 |
---|---|
Provider Name | Robert J Giordano |
First Address | Southbridge, MA 01550 |
Second Address | Southbridge, MA 01550 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3033309 | (05) | MA |
A24510 | (02) |