Healthcare Provider Details

I. General information

NPI: 1376177790
Provider Name (Legal Business Name): GREATER BOSTON ALLERGY ASTHMA SINUS & IMMUNOLOGY CENTERS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2020
Last Update Date: 08/05/2023
Certification Date: 08/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 W MAIN ST
HYANNIS MA
02601-3644
US

IV. Provider business mailing address

433 W MAIN ST
HYANNIS MA
02601-3644
US

V. Phone/Fax

Practice location:
  • Phone: 508-362-0099
  • Fax:
Mailing address:
  • Phone: 508-362-0099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN JOHNSON
Title or Position: OWNER
Credential: DO
Phone: 978-604-1316