Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 150067 | MA |
Y | 207RC0000X | Internist - Cardiovascular Disease | 150067 | MA |
NPI | 1568445294 |
---|---|
Provider Name | Theo E Meyer |
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 | 28/11/2005 |
Last Update Date | 12/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110054155A | (05) | MA |
3121895 | (05) | MA |
F73190 | (02) | MA |