| NPI | 1528097755 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | JUDITH GILMARTIN PACKER Manager 617-519-6099  | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA 178677)  | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 47735)  | 
| Enumeration Date | 2006-07-01 | 
| Last Update Date | 2025-09-11 |