Basic Information
| Provider Information | |||||||||
| NPI: | 1245248970 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRUNSWICK GASTROENTEROLOGY ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 121 MEDICAL CENTER DR | ||||||||
| Address2: | SUITE 3400 | ||||||||
| City: | BRUNSWICK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040112653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077251355 | ||||||||
| FaxNumber: | 2077291457 | ||||||||
| Practice Location | |||||||||
| Address1: | 121 MEDICAL CENTER DR | ||||||||
| Address2: | SUITE 3400 | ||||||||
| City: | BRUNSWICK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040112653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077251355 | ||||||||
| FaxNumber: | 2077291457 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BOSCO | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | JAY | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 2077251355 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.