Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 77466 | MA |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 77466 | MA |
NPI | 1114925211 |
---|---|
Provider Name | Thomas D Shipp |
First Address | Worcester, MA 01608-1604 |
Second Address | Brookline, MA 02445-7224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 08/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3116689 | (05) | MA |
F69163 | (02) |