MEDICARE: BOSTON PSYCHIATRIC ALLIANCE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1891577664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOSTON PSYCHIATRIC ALLIANCE

Provider Business Mailing Address
First Line	:	26 WOLCOTT RD
Second Line	:
City	:	MILTON
State	:	MA
Zip	:	02186-1222
Country	:	US
Telephone Number	:	617-291-1440
Fax Number	:	617-361-1105

Provider Business Practice Location Address
First Line	:	26 WOLCOTT RD
Second Line	:
City	:	MILTON
State	:	MA
Zip	:	02186-1222
Country	:	US
Telephone Number	:	617-291-1440
Fax Number	:	617-361-1105

Authorized Official
Title or Position	:	DIRECTOR/PRESIDENT
Name	:	JAN PETER URKEVIC
Credential	:	MD
Telephone Number	:	617-291-1440

Provider Enumeration Date	:	10/17/2023
Last Update Date	:	10/17/2023

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Directions to “BOSTON PSYCHIATRIC ALLIANCE ” Practice Location

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