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General NPI Number Information
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NPI Number | 1083802953
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Entity Type | Organization
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Legal Business Name | AMY EDALJI MD & R ROGER KOMER MD
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 03/26/2020
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Provider Practice Location Address
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Address Line | 1180 BEACON ST SUITE 5A
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City | BROOKLINE
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State | MA
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Zip | 02446-3885
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Country | US
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Telephone | 617-739-6300
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Fax | 617-734-8484
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Provider Business Mailing Address
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Address Line | 1180 BEACON ST SUITE 5A
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City | BROOKLINE
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State | MA
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Zip | 02446-3885
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Country | US
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Telephone | 617-739-6300
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Fax | 617-734-8484
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Authorized Official
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Title or Position | PHYSICIAN
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Name | R ROGER KOMER
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Credential |
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Telephone | 617-739-6300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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