Individual
MS. FAYE COBB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17 GREENVILLE ST, ROXBURY, MA 02119-2315
(617) 445-6972
Mailing address
45 CRESCENT ST # 1, QUINCY, MA 02169-4010
(857) 505-9257
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100006636862
MASS HEALTH
MA
Enumeration date
11/19/2020
Last updated
11/19/2020
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