Individual
SURAJ BOWRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
133 BROOKLINE AVE, BOSTON, MA 02215-3904
(617) 421-1999
(617) 421-6084
Mailing address
147 MILK ST, PROVIDER ENROLLMENT - 9TH FLOOR, BOSTON, MA 02109-4806
(617) 421-2508
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
34157
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000848
NEIGHBORHOOD HEALTH PLAN
MA
01
—
1671818-001
CIGNA
MA
05
—
2026139
—
MA
01
—
739780
TUFTS
MA
01
—
B21211601
HEALTHSOURCE
MA
01
—
C05072
BLUE CROSS
MA
01
—
R122
HARVARD PILGRIM
MA
Enumeration date
03/22/2006
Last updated
08/02/2013
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