Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 59751 | MA |
NPI | 1104901396 |
---|---|
Provider Name | Wayne A Marasco |
First Address | Boston, MA 02115-6013 |
Second Address | Boston, MA 02115-6013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 08/07/2007 |