Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 32695 | MA |
NPI | 1699853820 |
---|---|
Provider Name | Theresia M Bajusz |
First Address | Boston, MA 02116 |
Second Address | Brookline, MA 02446 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E03272 | (02) | |
M08592 | BCBS (01) |