Healthcare Provider Details

I. General information

NPI: 1730361197
Provider Name (Legal Business Name): BOSTON UNIVERSITY GENERAL SURGICAL ASSOCIATES, INC. - PODIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 HARRISON AVE PRESTON 2
BOSTON MA
02118-2309
US

IV. Provider business mailing address

732 HARRISON AVE PRESTON 2
BOSTON MA
02118-2309
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-6840
  • Fax: 617-414-6710
Mailing address:
  • Phone: 617-414-6840
  • Fax: 617-414-6710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES M BECKER
Title or Position: CHAIRMAN
Credential: MD
Phone: 617-638-8600