Provider Demographics
NPI:1467575951
Name:BOMAN SURGICAL SPECIALISTS,PC
Entity Type:Organization
Organization Name:BOMAN SURGICAL SPECIALISTS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-679-7369
Mailing Address - Street 1:300 HANOVER ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-5444
Mailing Address - Country:US
Mailing Address - Phone:508-679-7369
Mailing Address - Fax:508-679-7750
Practice Address - Street 1:300 HANOVER ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5444
Practice Address - Country:US
Practice Address - Phone:508-679-7369
Practice Address - Fax:508-679-7750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA60137174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MABS44124Medicaid
MAD165OtherHARVARD PILGRIM
MABC BS OF MAOtherM18033
MABC BS OF MAOtherM18033