Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 258258 | MA |
N | 207RC0000X | Internist - Cardiovascular Disease | 258258 | MA |
NPI | 1942594882 |
---|---|
Provider Name | Roy Sriwattanakomen |
First Address | Plymouth, MA 02360 |
Second Address | Boston, MA 02215-5400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2011 |
Last Update Date | 17/08/2020 |