Individual
DR. MILLARD THOMAS HENNESSEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M
Contact information
Practice address
654 E BROADWAY, BOSTON, MA 02127-1502
(617) 268-1745
(617) 268-1748
Mailing address
654 E BROADWAY, BOSTON, MA 02127-1502
(617) 268-1745
(617) 268-1748
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
001614
MA
332B00000X
Durable Medical Equipment & Medical Supplies
001614
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0341487
—
MA
01
—
Y70691
BLUE SHIELD
MA
Enumeration date
07/07/2006
Last updated
08/16/2012
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