Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 58960 | MA |
Y | 2080P0214X | Pediatric Pulmonologist | 58960 | MA |
NPI | 1477553923 |
---|---|
Provider Name | Virginia S Kharasch |
First Address | Brighton, MA 02135-0014 |
Second Address | Brighton, MA 02135-3602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2005 |
Last Update Date | 29/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3055736 | (05) | MA |
E94315 | (02) |