Healthcare Provider Details

I. General information

NPI: 1790752269
Provider Name (Legal Business Name): ALEXANDER M NORBASH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 E NEWTON ST DEPT RADIOLOGY
BOSTON MA
02118-2308
US

IV. Provider business mailing address

850 HARRISON AVE YACC BN-C7
BOSTON MA
02118-4001
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-6610
  • Fax: 617-638-6616
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number158213
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number158213
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: