Individual
DR. MARIA C PROM DE ILLANES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1 BOSTON MEDICAL CTR PL, BOSTON, MA 02118-2908
(617) 414-5245
Mailing address
960 MASSACHUSETTS AVE, FL 2, BOSTON, MA 02118
Taxonomy
Speciality
Code
Description
License number
State
2084P0015X
Psychosomatic Medicine Physician
Primary
269371
MA
2084P0800X
Psychiatry Physician
269371
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110106417A
—
MA
Enumeration date
06/06/2014
Last updated
12/18/2023
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