Basic Information
| Provider Information | |||||||||
| NPI: | 1003806282 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SYSTROM | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | MURRAY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 FRANCIS ST | ||||||||
| Address2: | CLINICS 3, PULMONARY, BWH | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021156110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175258986 | ||||||||
| FaxNumber: | 6177327421 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 FRANCIS ST | ||||||||
| Address2: | CLINICS 3, PULMONARY, BWH | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021156110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175258986 | ||||||||
| FaxNumber: | 6177327421 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2005 | ||||||||
| LastUpdateDate: | 08/29/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 51961 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | 51961 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 051961 | 01 | MA | TUFTS HEALTH PLAN | OTHER | J05462 | 01 | MA | BCBS MA | OTHER | 3011798 | 05 | MA | MEDICAID |