MEDICARE: MARYANNE C BOMBAUGH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	75493	MA

General Provider Information

NPI Number	:	1962477224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYANNE C BOMBAUGH M.D.

Provider Business Mailing Address
First Line	:	107 COMMERCIAL ST
Second Line	:
City	:	MASHPEE
State	:	MA
Zip	:	02649-6507
Country	:	US
Telephone Number	:	508-539-6000
Fax Number	:	508-477-7028

Provider Business Practice Location Address
First Line	:	118 LONG POND RD
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-2662
Country	:	US
Telephone Number	:	508-830-3190
Fax Number	:	781-340-3782

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	07/28/2016

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