Provider Demographics
NPI:1881638955
Name:BOMBA, GARRETT JAMES (MD)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:JAMES
Last Name:BOMBA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:360 MERRIMACK ST
Mailing Address - Street 2:@ RIVERWALK
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1740
Mailing Address - Country:US
Mailing Address - Phone:978-557-8800
Mailing Address - Fax:978-557-8633
Practice Address - Street 1:360 MERRIMACK ST
Practice Address - Street 2:@ RIVERWALK
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1740
Practice Address - Country:US
Practice Address - Phone:978-557-8800
Practice Address - Fax:978-557-8633
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2015-12-14
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Provider Licenses
StateLicense IDTaxonomies
NH12231207P00000X
MA229944207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1881638955OtherUNITED HEALTHCARE
MAAA200539OtherHPHC
MA110087989AMedicaid
MA0681385OtherNEIGHBORHOOD HEALTH PLAN
MA1881638955OtherAETNA
1881638955OtherFALLON COMMUNITY HEALTH PLAN
NH30204353Medicaid
MA95300503OtherNETWORK HEALTH
MAP00935898OtherRR MEDICARE
MA1881638955OtherBCBS
MA1881638955OtherEVERCARE
MA1881638955OtherANTHEM
MA1881638955OtherBOSTON MEDICAL CENTER HEALTH PLAN
MA1881638955OtherPHCS
MA449377OtherTUFTS
MA7548973OtherCIGNA
MA1881638955OtherAETNA
NHI09141Medicare UPIN