MEDICARE: VEIN AND AESTHETIC CENTER OF BOSTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician		MA
2	202K00000X	Phlebology Physician		MA

General Provider Information

NPI Number	:	1366420101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VEIN AND AESTHETIC CENTER OF BOSTON

Provider Business Mailing Address
First Line	:	340 MAIN ST
Second Line	:	STE. 670
City	:	WORCESTER
State	:	MA
Zip	:	01608-1604
Country	:	US
Telephone Number	:	508-754-3566
Fax Number	:	508-798-8012

Provider Business Practice Location Address
First Line	:	333 ELM ST
Second Line	:	STE. 205
City	:	DEDHAM
State	:	MA
Zip	:	02026-4530
Country	:	US
Telephone Number	:	781-251-0029
Fax Number	:	781-251-0229

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ELIZABETH A FOLEY
Credential	:	M.D.
Telephone Number	:	781-251-0029

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	07/21/2022

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