Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | 35482 | MA |
NPI | 1285686170 |
---|---|
Provider Name | Thomas P Smith |
First Address | Gloucester, MA 01930-2237 |
Second Address | Gloucester, MA 01930-2237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 28/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2015404 | (05) | MA |
D94054 | (02) | MA |