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General NPI Number Information
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NPI Number | 1144656364
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Entity Type | Organization
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Legal Business Name | JOHN L. NILES MD, PLLC
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Dates
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Enumeration Date | 09/19/2013
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Last Update Date | 02/04/2015
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Provider Practice Location Address
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Address Line | 101 MERRIMAC ST 1ST FLOOR
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City | BOSTON
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State | MA
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Zip | 02114-4724
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Country | US
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Telephone | 617-726-4132
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Fax | 617-726-4213
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Provider Business Mailing Address
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Address Line | 101 MERRIMAC ST 1ST FLOOR
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City | BOSTON
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State | MA
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Zip | 02114-4724
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Country | US
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Telephone | 617-726-4132
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Fax | 617-726-4213
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN L NILES
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Credential | M.D.
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Telephone | 617-726-4132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 54243
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License Number State | MA
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