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General NPI Number Information
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NPI Number | 1003770736
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Entity Type | Organization
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Legal Business Name | CODMAN SQUARE HEALTH CENTER
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Dates
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Enumeration Date | 12/16/2025
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 42 HIGHLAND AVENUE
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City | RANDOLPH
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State | MA
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Zip | 02368-0000
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Country | US
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Telephone | 617-825-9660
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Fax | 617-288-7898
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Provider Business Mailing Address
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Address Line | 637 WASHINGTON ST
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City | DORCHESTER
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State | MA
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Zip | 02124-3510
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Country | US
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Telephone | 617-825-9660
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Fax | 617-288-7898
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Authorized Official
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Title or Position | CEO
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Name | GUY FISH
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Credential |
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Telephone | 617-825-9660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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