Individual
AMA ANNOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
72 E CONCORD ST, BOSTON, MA 02118-2642
(713) 798-5588
Mailing address
72 E CONCORD ST, BOSTON, MA 02118-2642
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
BP10060313
TX
Other
Enumeration date
06/01/2017
Last updated
09/21/2020
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