Provider Demographics
NPI:1881638955
Name:BOMBA, GARRETT JAMES (MD)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:JAMES
Last Name:BOMBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 810
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-0810
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:273 COUNTY RD
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257-5736
Practice Address - Country:US
Practice Address - Phone:603-526-2911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229944207P00000X
NH12231207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110087989AMedicaid
1881638955OtherFALLON COMMUNITY HEALTH PLAN
MA7548973OtherCIGNA
MA0681385OtherNEIGHBORHOOD HEALTH PLAN
MA1881638955OtherANTHEM
MA1881638955OtherEVERCARE
MA1881638955OtherUNITED HEALTHCARE
MAP00935898OtherRR MEDICARE
MA1881638955OtherBCBS
MA1881638955OtherAETNA
NH30204353Medicaid
MAAA200539OtherHPHC
MA1881638955OtherPHCS
MA95300503OtherNETWORK HEALTH
MA1881638955OtherBOSTON MEDICAL CENTER HEALTH PLAN
MA449377OtherTUFTS
MA1881638955OtherAETNA
NHI09141Medicare UPIN