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General NPI Number Information
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NPI Number | 1326179532
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Entity Type | Organization
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Legal Business Name | FACULTY PRACTICE FOUNDATION , EVANS MEDICAL FOUNDATION
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 06/15/2011
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Provider Practice Location Address
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Address Line | 930 COMMONWEALTH AVE
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City | BOSTON
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State | MA
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Zip | 02215-1274
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Country | US
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Telephone | 617-414-6600
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Fax | 617-414-6601
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Provider Business Mailing Address
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Address Line | 930 COMMONWEALTH AVE
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City | BOSTON
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State | MA
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Zip | 02215-1274
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Country | US
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Telephone | 617-414-6600
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Fax | 617-414-6601
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. ANNMARIE CLOONAN
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Credential |
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Telephone | 617-638-7231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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