Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 227877 | MA |
N | 207SG0201X | Clinical Genetics (M.D.) | 227877 | MA |
NPI | 1740207331 |
---|---|
Provider Name | Vijay R Hegde |
First Address | Jamaica Plain, MA 02130-1927 |
Second Address | Jamaica Plain, MA 02130-1927 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 05/07/2013 |