Healthcare Provider Details

I. General information

NPI: 1972630028
Provider Name (Legal Business Name): BOWDOIN STREET HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 BOWDOIN ST
DORCHESTER MA
02122-1817
US

IV. Provider business mailing address

230 BOWDOIN ST
DORCHESTER MA
02122-1817
US

V. Phone/Fax

Practice location:
  • Phone: 617-754-0100
  • Fax: 617-754-0220
Mailing address:
  • Phone: 617-754-0100
  • Fax: 617-754-0220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateMA

VIII. Authorized Official

Name: MS. ADELA MARGULES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 617-754-0200