1508830522 NPI number — TALAL J BOU-HARB MD

Table of content: TALAL J BOU-HARB MD (NPI 1508830522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508830522 NPI number — TALAL J BOU-HARB MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOU-HARB
Provider First Name:
TALAL
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508830522
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 415348
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-5348
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-225-8885
Provider Business Mailing Address Fax Number:
508-334-1977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPENCER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01562-2621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-885-3025
Provider Business Practice Location Address Fax Number:
508-885-4090
Provider Enumeration Date:
02/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  80602 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 043058466002 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110166307 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 784247 . This is a "MVP HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA1196 . This is a "HARVARD PILGRIM HLTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: J16105 . This is a "BLUE SHIELD HMO BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5098641 . This is a "CIGNA HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: J16105 . This is a "BLUE SHIELD INDEMNITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "PRIVATE HEALTHCARE SYST" identifier . This identifiers is of the category "OTHER".
  • Identifier: J16105 . This is a "BLUE CARE ELECT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 043058466 . This is a "HEALTHCARE VALUE MGMT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 872046 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0401738 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "THREE RIVERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2017162 . This is a "US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3137201 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 042472266 . This is a "ONE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2017162 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 33751 . This is a "FALLON COMM. HEALTH PLAN" identifier . This identifiers is of the category "OTHER".




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