Healthcare Provider Details

I. General information

NPI: 1144490988
Provider Name (Legal Business Name): BORIS BALSON, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 BEACON ST STE 6A
BROOKLINE MA
02446-3806
US

IV. Provider business mailing address

50-56 BROADLAWN PARK APT 404
CHESTNUT HILL MA
02467-3511
US

V. Phone/Fax

Practice location:
  • Phone: 617-731-1203
  • Fax:
Mailing address:
  • Phone: 617-731-1203
  • Fax: 617-731-8466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License Number151394
License Number StateMA

VIII. Authorized Official

Name: VERA CACCAVARO
Title or Position: OFFICE MANAGER
Credential:
Phone: 781-933-3734