Healthcare Provider Details

I. General information

NPI: 1003721911
Provider Name (Legal Business Name): GREATER BOSTON GASTROENTEROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

492 OLD CONNECTICUT PATH STE 200
FRAMINGHAM MA
01701-4583
US

IV. Provider business mailing address

492 OLD CONNECTICUT PATH STE 200
FRAMINGHAM MA
01701-4583
US

V. Phone/Fax

Practice location:
  • Phone: 601-214-5172
  • Fax: 508-620-6483
Mailing address:
  • Phone: 601-214-5172
  • Fax: 508-620-6483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDRES D MOGOLLON
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 601-214-5172