Provider Demographics
NPI:1013537554
Name:BOSE, GAURUV (MD)
Entity Type:Individual
Prefix:DR
First Name:GAURUV
Middle Name:
Last Name:BOSE
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:THE OTTAWA HOSPITAL CIVIC CAMPUS DEPT OF NEUROLOGY
Mailing Address - Street 2:1053 CARLING AVENUE. ROOM C2196
Mailing Address - City:OTTAWA
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:K1Y 4E9
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:THE OTTAWA HOSPITAL CIVIC CAMPUS DEPT OF NEUROLOGY
Practice Address - Street 2:1053 CARLING AVENUE. ROOM C2196
Practice Address - City:OTTAWA
Practice Address - State:ONTARIO
Practice Address - Zip Code:K1Y 4E9
Practice Address - Country:CA
Practice Address - Phone:613-798-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106281390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
106281OtherCOLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO