Provider Demographics
NPI:1316114994
Name:SPOERRI-BOWMAN, REBECCA (DO)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:SPOERRI-BOWMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CAMBRIDGE ST
Mailing Address - Street 2:#380
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-3766
Mailing Address - Country:US
Mailing Address - Phone:781-272-0379
Mailing Address - Fax:781-272-7257
Practice Address - Street 1:101 CAMBRIDGE STREET, SUITE 380
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-2900
Practice Address - Country:US
Practice Address - Phone:781-272-0379
Practice Address - Fax:781-272-7257
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235476207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA122620Medicaid