Active NPI
Robert D Fusunyan, MD
- Pediatric Gastroenterology Physician
- Waltham, MA
National Provider Identifier
1104817717
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Gastroenterology Physician
- License
- 78425
- Practice address
- 40 2ND Avenue
Suite 340
Waltham, MA 02451-1132 - Phone
- (781) 466-8967
- Fax
- (781) 466-8987
- NPI assigned
- Nov 2, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 78425 | MA | |
| Pediatric Gastroenterology Physician | 2080P0206X | 78425 | MA | Primary |
Addresses
Primary practice location
40 2ND Avenue
Suite 340
Waltham, MA 02451-1132
Mailing address
44 North Street
Lexington, MA 02420
Phone (781) 862-1652
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 750032 | Other | MA | TUFTS HEALTH PLAN |
| 3159337 | Medicaid | MA | |
| J17154 | Other | MA | BCBS MA |
Other names 1
- Dr. Robert D Fu
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130889600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251936000000",
"number": "1104817717",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "44 NORTH STREET",
"city": "LEXINGTON",
"state": "MA",
"postal_code": "02420",
"telephone_number": "781-862-1652",
"fax_number": "781-862-1652"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40 2ND AVENUE",
"address_2": "SUITE 340",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024511132",
"telephone_number": "781-466-8967",
"fax_number": "781-466-8987"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUSUNYAN",
"first_name": "ROBERT",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-02",
"last_updated": "2009-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MA",
"license": "78425",
"primary": false
},
{
"code": "2080P0206X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Gastroenterology",
"state": "MA",
"license": "78425",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS HEALTH PLAN",
"identifier": "750032",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3159337",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS MA",
"identifier": "J17154",
"state": "MA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "ROBERT",
"last_name": "FU",
"middle_name": "D",
"prefix": "DR.",
"credential": "MD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Waltham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.