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General NPI Number Information
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NPI Number | 1740839208
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Entity Type | Organization
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Legal Business Name | BOSTON SENIOR MEDICINE
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Dates
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Enumeration Date | 09/08/2019
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Last Update Date | 11/20/2019
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Provider Practice Location Address
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Address Line | 345 NEPONSET ST
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City | CANTON
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State | MA
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Zip | 02021-1940
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Country | US
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Telephone | 508-232-6963
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Fax | 508-297-8258
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Provider Business Mailing Address
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Address Line | 345 NEPONSET ST STE 3
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City | CANTON
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State | MA
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Zip | 02021-1988
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Country | US
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Telephone | 508-232-6963
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Fax | 508-297-8258
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Authorized Official
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Title or Position | PROVIDER
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Name | INDIA MICHEL
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Credential | NP
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Telephone | 508-232-6963
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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