Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 53193 | MA |
NPI | 1174597983 |
---|---|
Provider Name | Roger Breitbart |
First Address | Boston, MA 02284-5628 |
Second Address | Boston, MA 02115-5724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2006 |
Last Update Date | 10/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003066653 | (05) | CT |
1098686 | (05) | NY |
30002638 | (05) | NH |
3036791 | (05) | MA |
B98210 | (02) |