Provider Demographics
NPI:1003806282
Name:SYSTROM, DAVID MURRAY (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MURRAY
Last Name:SYSTROM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:CLINICS 3, PULMONARY, BWH
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:617-525-8986
Mailing Address - Fax:617-732-7421
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:CLINICS 3, PULMONARY, BWH
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-525-8986
Practice Address - Fax:617-732-7421
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA51961207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA051961OtherTUFTS HEALTH PLAN
MAJ05462OtherBCBS MA
MA3011798Medicaid
MAJ05462Medicare ID - Type Unspecified
MA051961OtherTUFTS HEALTH PLAN