Basic Information
Provider Information
NPI: 1003806282
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SYSTROM
FirstName: DAVID
MiddleName: MURRAY
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X51961MAN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RP1001X51961MAY Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease

ID Information
IDTypeStateIssuerDescription
05196101MATUFTS HEALTH PLANOTHER
301179805MA MEDICAID
J0546201MABCBS MAOTHER


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