Provider Demographics
NPI:1073587291
Name:BUSSE, PAUL MARTIN (PHD MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MARTIN
Last Name:BUSSE
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Gender:M
Credentials:PHD MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-1548
Mailing Address - Fax:617-724-8334
Practice Address - Street 1:100 BLOSSOM ST
Practice Address - Street 2:COX LL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2617
Practice Address - Country:US
Practice Address - Phone:617-724-1548
Practice Address - Fax:617-724-8334
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2016-04-19
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Provider Licenses
StateLicense IDTaxonomies
MA556492085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3039323Medicaid
MAJ07816OtherBCBS MA
MA733294OtherTUFTS HEALTH PLAN
MA3039323Medicaid
MAJ07816Medicare PIN