Healthcare Provider Details

I. General information

NPI: 1346231792
Provider Name (Legal Business Name): GUY NUBAR PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 WASHINGTON ST EMERGENCY DEPT
TAUNTON MA
02780-2465
US

IV. Provider business mailing address

460 TOTTEN POND RD
WALTHAM MA
02451-1906
US

V. Phone/Fax

Practice location:
  • Phone: 508-828-7100
  • Fax: 508-828-7158
Mailing address:
  • Phone: 781-890-9933
  • Fax: 781-890-9950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number953
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: