Individual
DR. ATHOS BOUSVAROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MPH
Contact information
Practice address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-2962
Mailing address
8 FRANCES RD, LEXINGTON, MA 02421-7512
(781) 623-3956
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
58765
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3074854
—
MA
Enumeration date
08/21/2006
Last updated
07/08/2007
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