Healthcare Provider Details

I. General information

NPI: 1851483614
Provider Name (Legal Business Name): BONNIE P. HERSH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 BROOKLINE AVE
BOSTON MA
02215-3904
US

IV. Provider business mailing address

133 BROOKLINE AVE
BOSTON MA
02215-3904
US

V. Phone/Fax

Practice location:
  • Phone: 617-421-1020
  • Fax: 617-421-1063
Mailing address:
  • Phone: 617-421-1020
  • Fax: 617-421-1063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number80786
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: