Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 265624 | MA |
NPI | 1023085214 |
---|---|
Provider Name | Tammy Lynn Gleeson |
First Address | Fairhaven, MA 02719-5255 |
Second Address | Fairhaven, MA 02719-5208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 22/04/2020 |