Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 51961 | MA |
N | 111NI0900X | Internist | 51961 | MA |
Y | 207RP1001X | Pulmonary Disease | 51961 | MA |
NPI | 1003806282 |
---|---|
Provider Name | Dr. David Murray Systrom |
First Address | Boston, MA 02115-6110 |
Second Address | Boston, MA 02115-6110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2005 |
Last Update Date | 29/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
051961 | TUFTS HEALTH PLAN (01) | MA |
3011798 | (05) | MA |
A58400 | (02) | |
J05462 | BCBS MA (01) | MA |