Healthcare Provider Details

I. General information

NPI: 1184867483
Provider Name (Legal Business Name): BELMONT MEDICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2009
Last Update Date: 04/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 CONCORD AVE SUITE 4100
CAMBRIDGE MA
02138-1040
US

IV. Provider business mailing address

725 CONCORD AVE SUITE 4100
CAMBRIDGE MA
02138-1040
US

V. Phone/Fax

Practice location:
  • Phone: 617-864-4108
  • Fax: 617-547-5367
Mailing address:
  • Phone: 617-864-4108
  • Fax: 617-547-5367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number47577
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number56978
License Number StateMA

VIII. Authorized Official

Name: JANET CONNORS
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 617-864-4108