Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 76423 | MA |
NPI | 1003882192 |
---|---|
Provider Name | Robert W. Hansen |
First Address | Boston, MA 02241-5348 |
Second Address | Worcester, MA 01655-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 20/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110053835A | (05) | MA |
F68905 | (02) | MA |