Healthcare Provider Details

I. General information

NPI: 1891034492
Provider Name (Legal Business Name): BOSTON MATERNAL-FETAL MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKLINE PL SUITE 301
BROOKLINE MA
02445-7224
US

IV. Provider business mailing address

1 BROOKLINE PL SUITE 301
BROOKLINE MA
02445-7224
US

V. Phone/Fax

Practice location:
  • Phone: 617-264-0364
  • Fax: 617-264-0365
Mailing address:
  • Phone: 617-264-0364
  • Fax: 617-264-0365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN HAMAR
Title or Position: CFO
Credential: MD
Phone: 617-823-4191