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General NPI Number Information
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NPI Number | 1376177790
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Entity Type | Organization
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Legal Business Name | GREATER BOSTON ALLERGY ASTHMA SINUS & IMMUNOLOGY CENTERS, P.C.
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Dates
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Enumeration Date | 02/25/2020
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Last Update Date | 08/05/2023
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Provider Practice Location Address
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Address Line | 433 W MAIN ST
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City | HYANNIS
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State | MA
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Zip | 02601-3644
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Country | US
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Telephone | 508-362-0099
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Fax |
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Provider Business Mailing Address
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Address Line | 433 W MAIN ST
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City | HYANNIS
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State | MA
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Zip | 02601-3644
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Country | US
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Telephone | 508-362-0099
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN JOHNSON
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Credential | DO
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Telephone | 978-604-1316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0201X
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Taxonomy Name | Pediatric Allergy/Immunology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RA0201X
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Taxonomy Name | Allergy & Immunology (Internal Medicine) Physician
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License Number |
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License Number State |
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