Healthcare Provider Details

I. General information

NPI: 1063431492
Provider Name (Legal Business Name): BOSTON PUBLIC HEALTH COMMISSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 ALBANY ST
BOSTON MA
02118-2520
US

IV. Provider business mailing address

1010 MASSACHUSETTS AVE
BOSTON MA
02118-2600
US

V. Phone/Fax

Practice location:
  • Phone: 617-534-4212
  • Fax:
Mailing address:
  • Phone: 617-534-4222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number0666
License Number StateMA

VIII. Authorized Official

Name: DR. BISOLA OJIKUTU
Title or Position: EXECUTIVE DIRECTOR
Credential: MD
Phone: 617-534-5264