Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 54640 | MA |
Y | 208600000X | Surgeon | 54640 | MA |
NPI | 1013024637 |
---|---|
Provider Name | Theodore J Patsos |
First Address | Boston, MA 02241-5348 |
Second Address | Milford, MA 01757-3039 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 05/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110044118A | (05) | MA |
A58323 | (02) | |
J05312 | BCBS (01) |