Healthcare Provider Details

I. General information

NPI: 1326122839
Provider Name (Legal Business Name): BOSTON IVF, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 2ND AVE BOSTON IVF, INC.
WALTHAM MA
02451-1100
US

IV. Provider business mailing address

130 2ND AVE BOSTON IVF, INC.
WALTHAM MA
02451-1100
US

V. Phone/Fax

Practice location:
  • Phone: 781-434-6500
  • Fax: 781-434-6501
Mailing address:
  • Phone: 781-434-6500
  • Fax: 781-434-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number StateMA

VIII. Authorized Official

Name: MR. DEREK M. LARKIN
Title or Position: DIRECTOR OF BUSINESS
Credential: JD, MBA
Phone: 781-434-6500