Healthcare Provider Details

I. General information

NPI: 1114918950
Provider Name (Legal Business Name): BOSTON MEDICAL CENTER CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 HARRISON AVE
BOSTON MA
02118-2905
US

IV. Provider business mailing address

840 HARRISON AVE
BOSTON MA
02118-2905
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-4883
  • Fax: 617-414-5397
Mailing address:
  • Phone: 617-414-4883
  • Fax: 617-414-5397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number339
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY HOLLENBERG
Title or Position: PRESIDENT
Credential:
Phone: 617-638-6903