Bourgeois, Blaise
Bourgeois, Blaise is an individual health care provider with primary practice located at 300 Longwood Ave Fegan 9, Boston MA 02115-5724. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Adolescent Medicine, Allopathic & Osteopathic Physicians / Neurology with Special Qualifications in Child Neurology. Allopathic & Osteopathic Physicians / Neurology with Special Qualifications in Child Neurology is his primary health care specialty. Bourgeois, Blaise can be contacted via phone (617) 355-2413.Contact Information
Primary practice address
300 Longwood Ave Fegan 9
Boston MA 02115-5724
Phone: (617) 355-2413
Fax: (617) 730-0463
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Adolescent Medicine | 2080A0000X | 156598 | Massachusetts |
| Allopathic & Osteopathic Physicians / Neurology with Special Qualifications in Child Neurology | 2084N0402X | 156598 | Massachusetts |
Profile Details
| NPI number | 1972536282 |
|---|---|
| LBN Legal business name | Bourgeois, Blaise |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 9th, 2006 |
| Last updated | Aug 24th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1972536282 | NPPES |
| Massachusetts | MEDICAID | 3183271 |
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