Provider Demographics
NPI:1962477224
Name:BOMBAUGH, MARYANNE C (MD)
Entity type:Individual
Prefix:
First Name:MARYANNE
Middle Name:C
Last Name:BOMBAUGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:107 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-6507
Mailing Address - Country:US
Mailing Address - Phone:508-539-6000
Mailing Address - Fax:508-477-7028
Practice Address - Street 1:118 LONG POND RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2662
Practice Address - Country:US
Practice Address - Phone:508-830-3190
Practice Address - Fax:781-340-3782
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA75493207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAF41188Medicare UPIN
MAJ13157Medicare ID - Type Unspecified