Provider Demographics
NPI:1508830522
Name:BOU-HARB, TALAL J (MD)
Entity Type:Individual
Prefix:
First Name:TALAL
Middle Name:J
Last Name:BOU-HARB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:118 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:MA
Practice Address - Zip Code:01562-2621
Practice Address - Country:US
Practice Address - Phone:508-885-3025
Practice Address - Fax:508-885-4090
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80602207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
043058466002OtherTRICARE
110166307OtherRAILROAD MEDICARE
784247OtherMVP HEALTH CARE
AA1196OtherHARVARD PILGRIM HLTHCARE
J16105OtherBLUE SHIELD HMO BLUE
5098641OtherCIGNA HEALTH PLAN
J16105OtherBLUE SHIELD INDEMNITY
042472266OtherPRIVATE HEALTHCARE SYST
J16105OtherBLUE CARE ELECT
043058466OtherHEALTHCARE VALUE MGMT
872046OtherFIRST HEALTH
0401738OtherEVERCARE
042472266OtherTHREE RIVERS
2017162OtherUS HEALTHCARE
MA3137201Medicaid
042472266OtherONE HEALTH PLAN
2017162OtherAETNA
33751OtherFALLON COMM. HEALTH PLAN
2017162OtherAETNA
MA3137201Medicaid