Basic Information
| Provider Information | |||||||||
| NPI: | 1407020415 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHATTERJEE | ||||||||
| FirstName: | AVIK | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 780 ALBANY ST | ||||||||
| Address2: | BOSTON HEALTH CARE FOR THE HOMELESS | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8576541000 | ||||||||
| FaxNumber: | 8576541100 | ||||||||
| Practice Location | |||||||||
| Address1: | 780 ALBANY ST | ||||||||
| Address2: | BOSTON HEALTH CARE FOR THE HOMELESS | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8576541000 | ||||||||
| FaxNumber: | 8576541100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2008 | ||||||||
| LastUpdateDate: | 02/02/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 050646 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 050646 | CT | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 254407 | MA | N | Allopathic & Osteopathic Physicians | Pediatrics | 2083A0300X | 254407 | MA | N | 207R00000X | 254407 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.