Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 287716 | MA |
N | 207R00000X | Internist | 287716 | MA |
N | 111NI0900X | Internist | 287716 | MA |
NPI | 1154775518 |
---|---|
Provider Name | Tina Motazedi |
First Address | Boston, MA 02114 |
Second Address | Boston, MA 02114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2016 |
Last Update Date | 20/07/2021 |