Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 275239 | MA |
Y | 208600000X | Surgeon | 275239 | MA |
NPI | 1003207762 |
---|---|
Provider Name | Vanessa Mercedes Welten |
First Address | Boston, MA 02115-6110 |
Second Address | Boston, MA 02115-6110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2015 |
Last Update Date | 13/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110135430A | MASS HEALTH PROVIDER NUMBER (01) | MA |
BB5204071 | DEA NUMBER (01) | MA |