Provider Demographics
NPI:1376170548
Name:BOTHWELL, MIA YU (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MIA
Middle Name:YU
Last Name:BOTHWELL
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:
Other - Last Name:YU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:GRAY BIGELOW 730
Mailing Address - Street 2:55 FRUIT STREET
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-726-5820
Mailing Address - Fax:
Practice Address - Street 1:GRAY BIGELOW 730
Practice Address - Street 2:55 FRUIT STREET
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-5820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program