Individual
PU NI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
75 FRANCIS STREET, COTRAN 360H, BOSTON, MA 02115
(617) 732-4699
Mailing address
75 FRANCIS ST, BOSTON, MA 02115-6110
(617) 732-4699
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
1021152
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/22/2021
Last updated
09/03/2025
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