Healthcare Provider Details

I. General information

NPI: 1477660058
Provider Name (Legal Business Name): SCOTT G PRUSHIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BOSTON MEDICAN CENTER ONE BOSTON MEDICAL CENTER PLACE
BOSTON MA
02118
US

IV. Provider business mailing address

960 MASSACHUSETTS AVENUE FL 2
BOSTON MA
02118-2690
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-8630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number226428
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number226428
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: