1437196359 NPI number — MEDICAL CARE OF BOSTON MANAGEMENT CORPORATION

Table of content: (NPI 1437196359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437196359 NPI number — MEDICAL CARE OF BOSTON MANAGEMENT CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL CARE OF BOSTON MANAGEMENT CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437196359
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 BLUE HILL DR
Provider Second Line Business Mailing Address:
SUITE 2B
Provider Business Mailing Address City Name:
WESTWOOD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02090-2164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-754-1023
Provider Business Mailing Address Fax Number:
617-754-1040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
464 HILLSIDE AVE
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
NEEDHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02494-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-754-0730
Provider Business Practice Location Address Fax Number:
617-754-0731
Provider Enumeration Date:
05/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHRISTOFORO
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
617-754-0745

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9780378 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com