Healthcare Provider Details

I. General information

NPI: 1558745547
Provider Name (Legal Business Name): NEW ENGLAND BAPTIST PRIMARY CARE ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PARKER HILL AVE
BOSTON MA
02120-2847
US

IV. Provider business mailing address

PO BOX 9132
BROOKLINE MA
02446-9132
US

V. Phone/Fax

Practice location:
  • Phone: 617-754-6742
  • Fax: 617-754-6443
Mailing address:
  • Phone: 800-927-0002
  • Fax: 603-890-1236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS GHERINGHELLI
Title or Position: CFO
Credential:
Phone: 617-754-5000