Healthcare Provider Details

I. General information

NPI: 1922504257
Provider Name (Legal Business Name): MARIE BANGURA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 S BEDFORD ST STE 300
BURLINGTON MA
01803-5108
US

IV. Provider business mailing address

67 S BEDFORD ST STE 300
BURLINGTON MA
01803-5108
US

V. Phone/Fax

Practice location:
  • Phone: 781-744-8560
  • Fax:
Mailing address:
  • Phone: 781-744-8560
  • Fax: 339-227-4444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number1024783
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: