Individual
DR. BLAIR WARDENBURG FOSBURGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
15 PARKMAN ST, INTERNAL MEDICINE ASSOCIATES TEAM 3, BOSTON, MA 02114-3117
(617) 724-4600
(617) 724-7799
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 724-4600
(617) 724-7799
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
151210
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3152057
—
MA
01
—
730829
TUFTS HEALTH PLAN
MA
01
—
J16876
BCBS MA
MA
Enumeration date
11/04/2005
Last updated
08/23/2012
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