Provider Demographics
NPI:1487764965
Name:BUZANIS, CHARLES T (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:T
Last Name:BUZANIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:133 BROOKLINE AVE FL 9
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-3904
Mailing Address - Country:US
Mailing Address - Phone:617-421-1091
Mailing Address - Fax:617-421-2555
Practice Address - Street 1:133 BROOKLINE AVE FL 9
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-3904
Practice Address - Country:US
Practice Address - Phone:617-421-1091
Practice Address - Fax:617-421-2555
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-02-02
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Provider Licenses
StateLicense IDTaxonomies
MA79160207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ30911OtherBLUE CROSS
MA079160OtherTUFTS HEALTH PLAN
MA4569412-002OtherCIGNA
MA3192512Medicaid
MAV515OtherHARVARD PILGRIM
MA0015305OtherNEIGHBORHOOD HEALTH PLAN
MA079160OtherTUFTS HEALTH PLAN
MA3192512Medicaid