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Provider Information for 1407382856

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1407382856

Calendar   Last Updated:  2021-07-12
  Certification Date:  2021-07-12


Name Value
NPI 1407382856
Enumeration Date 2017-05-04
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 20 CHAPEL ST
BROOKLINE, MA 02446-7458
United States

Phone: | Fax:
View Map External Link
Primary Practice Address 75 FRANCIS ST
BOSTON, MA 02115-6110
United States

Phone: 617-732-5500 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 207R00000X - Internal Medicine MA 287272
No 390200000X - Student in an Organized Health Care Education/Training Program