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General NPI Number Information
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NPI Number | 1821151572
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Entity Type | Organization
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Legal Business Name | BACK BAY ALLERGY ASSOCIATES LLC
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Dates
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Enumeration Date | 12/17/2006
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Last Update Date | 07/15/2015
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Provider Practice Location Address
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Address Line | 1101 BEACON ST
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City | BROOKLINE
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State | MA
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Zip | 02446-5587
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Country | US
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Telephone | 617-734-2202
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Fax | 617-734-2408
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Provider Business Mailing Address
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Address Line | 1101 BEACON ST SUITE 7 EAST
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City | BROOKLINE
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State | MA
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Zip | 02446-5587
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Country | US
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Telephone | 617-734-2202
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Fax | 617-734-2408
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Authorized Official
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Title or Position | MANAGER
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Name | DR. MARTIN GEORGE OSTRO
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Credential | M.D.
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Telephone | 617-734-2202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 30946
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License Number State | MA
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