Healthcare Provider Details

I. General information

NPI: 1013537554
Provider Name (Legal Business Name): GAURUV BOSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THE OTTAWA HOSPITAL CIVIC CAMPUS DEPT OF NEUROLOGY 1053 CARLING AVENUE. ROOM C2196
OTTAWA ONTARIO
K1Y 4E9
CA

IV. Provider business mailing address

THE OTTAWA HOSPITAL CIVIC CAMPUS DEPT OF NEUROLOGY 1053 CARLING AVENUE. ROOM C2196
OTTAWA ONTARIO
K1Y 4E9
CA

V. Phone/Fax

Practice location:
  • Phone: 613-798-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number106281
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: