Individual
DR. JAG BHAWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
725 ALBANY ST, SHAPIRO 8, BOSTON, MA 02118-2526
(617) 638-7420
(617) 638-7289
Mailing address
720 HARRISON AVE, DOB 503, BOSTON, MA 02118-2371
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
41853
MA
207ND0900X
Dermatopathology Physician
41853
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110037446A
—
MA
Enumeration date
10/31/2005
Last updated
05/20/2014
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