Individual
KOENRAAD MAX MORTELE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Contact information
Practice address
75 FRANCIS ST, RADIOLOGY BRIGHAMT WOMENS HOSPITAL, BOSTON, MA 02115-6110
(617) 732-7624
Mailing address
75 FRANCIS ST, RADIOLOGY BRIGHAMT WOMENS HOSPITAL, BOSTON, MA 02115-6110
(617) 732-7624
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
223120
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
213484
TUFTS HEALTH CARE
MA
01
—
J24540
BLUE CROSS BLUE SHIELD
MA
Enumeration date
12/13/2005
Last updated
07/08/2007
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