Basic Information
| Provider Information | |||||||||
| NPI: | 1306150495 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOSTON MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 85 EAST CONCORD ST | ||||||||
| Address2: | 5TH FLOOR ROOM 5520 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176386500 | ||||||||
| FaxNumber: | 6176386501 | ||||||||
| Practice Location | |||||||||
| Address1: | 72 E CONCORD ST | ||||||||
| Address2: | EVANS 124 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176386500 | ||||||||
| FaxNumber: | 6176386501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2010 | ||||||||
| LastUpdateDate: | 07/30/2010 | ||||||||
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| AuthorizedOfficialLastName: | DAVIDOFF | ||||||||
| AuthorizedOfficialFirstName: | RAVIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CMO | ||||||||
| AuthorizedOfficialTelephone: | 6176385423 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 245729 | MA | Y | Hospitals | General Acute Care Hospital |
No ID Information.