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General NPI Number Information
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NPI Number | 1497947899
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Entity Type | Organization
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Legal Business Name | BOSTON MEDICAL CENTER
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Dates
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Enumeration Date | 08/10/2007
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Last Update Date | 10/05/2007
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Provider Practice Location Address
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Address Line | 272 ALBION ST APT 3
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City | WAKEFIELD
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State | MA
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Zip | 01880-3154
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Country | US
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Telephone | 781-718-0199
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Fax |
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Provider Business Mailing Address
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Address Line | 85 E NEWTON ST 6TH FLOOR ROOM 601
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City | BOSTON
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State | MA
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Zip | 02118-2340
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Country | US
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Telephone | 617-414-8331
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Fax | 617-414-8319
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Authorized Official
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Title or Position | MEDICAL DIRECTOR CSU
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Name | ANNA FITZGERALD
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Credential | MD
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Telephone | 617-414-4242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 268132
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License Number State | MA
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