MEDICARE: BOSTON CBOC

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	261QV0200X	VA Clinic/Center

General Provider Information

NPI Number	:	1366495558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOSTON CBOC

Provider Business Mailing Address
First Line	:	150 S HUNTINGTON AVE
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-4817
Country	:	US
Telephone Number	:	617-232-9500
Fax Number	:	617-278-4549

Provider Business Practice Location Address
First Line	:	150 S HUNTINGTON AVE
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-4817
Country	:	US
Telephone Number	:	617-232-9500
Fax Number	:	617-278-4549

Authorized Official
Title or Position	:	DIRECTOR, BUSINESS DEVELOPMENT
Name	:	BARBARA MAYERICK
Credential	:
Telephone Number	:	202-254-0339

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	08/07/2008

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Directions to “BOSTON CBOC ” Practice Location

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