Healthcare Provider Details

I. General information

NPI: 1366495558
Provider Name (Legal Business Name): BOSTON CBOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S HUNTINGTON AVE
JAMAICA PLAIN MA
02130-4817
US

IV. Provider business mailing address

150 S HUNTINGTON AVE
JAMAICA PLAIN MA
02130-4817
US

V. Phone/Fax

Practice location:
  • Phone: 617-232-9500
  • Fax: 617-278-4549
Mailing address:
  • Phone: 617-232-9500
  • Fax: 617-278-4549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BARBARA MAYERICK
Title or Position: DIRECTOR, BUSINESS DEVELOPMENT
Credential:
Phone: 202-254-0339