Individual
DR. AMITABH GAUTAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
725 ALBANY ST, SHAPIRO 7TH FLOOR, SUITE 7A, BOSTON, MA 02118-2526
(617) 638-8430
(617) 638-8427
Mailing address
720 HARRISON AVE, DOB 503, BOSTON, MA 02118-2371
Taxonomy
Speciality
Code
Description
License number
State
204F00000X
Transplant Surgery Physician
Primary
233660
MA
208600000X
Surgery Physician
233660
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110003575A
—
MA
05
—
9023429
—
RI
Enumeration date
07/14/2005
Last updated
06/13/2014
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