Active NPI
T Edward Bynum, MD
- Gastroenterology Physician
- Marlboro, MA
National Provider Identifier
1790866655
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- 44316
- Practice address
- 65 Fremont St
Marlboro, MA 01752 - Phone
- (508) 624-0605
- Fax
- (508) 229-8694
- NPI assigned
- Oct 18, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | 44316 | MA | Primary |
Addresses
Primary practice location
65 Fremont St
Marlboro, MA 01752
Mailing address
65 Fremont St
Marlboro, MA 01752
Phone (508) 624-0605
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2070235 | Medicaid | MA |
Other names 1
- Turner Edward Bynum
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)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 44316 | MA | MD | Gastroenterology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1790866655",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "65 FREMONT ST",
"city": "MARLBORO",
"state": "MA",
"postal_code": "01752",
"telephone_number": "508-624-0605",
"fax_number": "508-229-8694"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "65 FREMONT ST",
"city": "MARLBORO",
"state": "MA",
"postal_code": "01752",
"telephone_number": "508-624-0605",
"fax_number": "508-229-8694"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BYNUM",
"first_name": "T",
"middle_name": "EDWARD",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "MA",
"license": "44316",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2070235",
"state": "MA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "TURNER",
"last_name": "BYNUM",
"middle_name": "EDWARD",
"code": "1",
"type": "Former Name"
}
]
}
Other providers in Marlboro, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.