Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 77419 | MA |
N | 2080P0201X | Pediatric Allergist | 77419 | MA |
NPI | 1184607665 |
---|---|
Provider Name | Thomas C Greenough |
First Address | Boston, MA 02241-5348 |
Second Address | Worcester, MA 01605-2903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2005 |
Last Update Date | 03/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110052966A | (05) | MA |
F56339 | (02) | MA |