Provider Demographics
NPI:1669594925
Name:BUKHMAN, GENE (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:GENE
Middle Name:
Last Name:BUKHMAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 HILLSIDE ST
Mailing Address - Street 2:#3
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02120-3255
Mailing Address - Country:US
Mailing Address - Phone:857-498-0541
Mailing Address - Fax:
Practice Address - Street 1:241 PERKINS ST
Practice Address - Street 2:APT J401
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-4002
Practice Address - Country:US
Practice Address - Phone:857-498-0541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-05
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216106207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA216106OtherSTATE MEDICAL LICENSE
MA216106OtherSTATE MEDICAL LICENSE