Healthcare Provider Details

I. General information

NPI: 1437798121
Provider Name (Legal Business Name): GBU CCH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2019
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 WASHINGTON ST STE 200
DEDHAM MA
02026-6022
US

IV. Provider business mailing address

910 WASHINGTON ST STE 200
DEDHAM MA
02026-6022
US

V. Phone/Fax

Practice location:
  • Phone: 718-762-0471
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL CURRIN
Title or Position: PRESIDENT
Credential: MD
Phone: 508-370-7703