MEDICARE: BLADDER HEALTH ASSOCIATES, L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1992970172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLADDER HEALTH ASSOCIATES, L.L.C.

Provider Business Mailing Address
First Line	:	112 HOMER ST
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02459-1518
Country	:	US
Telephone Number	:	508-951-4321
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 HOMER ST
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02459-1518
Country	:	US
Telephone Number	:	508-951-4321
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RALPH PHILOSOPHE
Credential	:	M.D.
Telephone Number	:	508-951-4321

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	04/28/2008

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