Healthcare Provider Details

I. General information

NPI: 1649500737
Provider Name (Legal Business Name): AURORA MASSACHUSETTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CENTER PLZ SUITE 270
BOSTON MA
02108-1887
US

IV. Provider business mailing address

1 CENTER PLZ SUITE 270
BOSTON MA
02108-1887
US

V. Phone/Fax

Practice location:
  • Phone: 877-628-3376
  • Fax:
Mailing address:
  • Phone: 877-628-3376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ELLEN CHANDLER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 603-778-8522