MEDICARE: J.EDMOND LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	204D00000X	Neuromusculoskeletal Medicine & OMM Physician
2	246RP1900X	Phlebotomy Technician
3	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1619567195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J.EDMOND LLC

Provider Business Mailing Address
First Line	:	1330 BOYLSTON ST UNIT 809
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02215-5524
Country	:	US
Telephone Number	:	410-935-4608
Fax Number	:

Provider Business Practice Location Address
First Line	:	1330 BOYLSTON ST UNIT 809
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02215-5524
Country	:	US
Telephone Number	:	410-935-4608
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEFFREY VOGEL
Credential	:	MD
Telephone Number	:	410-935-4608

Provider Enumeration Date	:	01/19/2021
Last Update Date	:	04/25/2022

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Directions to “J.EDMOND LLC ” Practice Location

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