Bhawna Awal
Individual provider Active NPI Specialist · Medford, MA
NPI 1356764708 · NPPES record last updated Jan 21, 2014
Key facts
- NPI
- 1356764708
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 18890 (MA)
- Practice address
- 200 Governors Ave
Medford, MA 02155-1644 - Phone
- (781) 391-5400
- NPI assigned
- Jan 21, 2014
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18890 | MA | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 18890 | MA | Yes |
Addresses
Primary practice location
200 Governors Ave
Medford, MA 02155-1644
Mailing address
812 Memorial Dr
Apt 1614
Cambridge, MA 02139-4638
Phone (917) 379-9258
Other providers in Medford, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.