Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 54786 | MA |
N | 208200000X | Surgeon | 54786 | MA |
N | 208600000X | Surgeon | 54786 | MA |
NPI | 1245210517 |
---|---|
Provider Name | William Lewis |
First Address | Burlington, MA 01805-0001 |
Second Address | Burlington, MA 01805-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 13/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110046239A | (05) | MA |
D87851 | (02) |