Healthcare Provider Details

I. General information

NPI: 1740839208
Provider Name (Legal Business Name): BOSTON SENIOR MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2019
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 NEPONSET ST
CANTON MA
02021-1940
US

IV. Provider business mailing address

345 NEPONSET ST STE 3
CANTON MA
02021-1988
US

V. Phone/Fax

Practice location:
  • Phone: 508-232-6963
  • Fax: 508-297-8258
Mailing address:
  • Phone: 508-232-6963
  • Fax: 508-297-8258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: INDIA MICHEL
Title or Position: PROVIDER
Credential: NP
Phone: 508-232-6963