Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 60359 | MA |
NPI | 1063481166 |
---|---|
Provider Name | Rock Elliott Ripple |
First Address | Norwood, MA 02062-3441 |
Second Address | Norwood, MA 02062-3441 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 27/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3062953 | (05) | MA |
E58338 | (02) | MA |