MEDICARE: BOSTON UNIVERSITY

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1619109816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOSTON UNIVERSITY

Provider Business Mailing Address
First Line	:	35 NORTHAMPTON ST APT 2202
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02118-4020
Country	:	US
Telephone Number	:	978-930-9467
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 NORTHAMPTON ST APT 2202
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02118-4020
Country	:	US
Telephone Number	:	978-930-9467
Fax Number	:

Authorized Official
Title or Position	:	PROSTHODONTIST
Name	:	DR. MARIUM HASAN
Credential	:
Telephone Number	:	978-930-9467

Provider Enumeration Date	:	08/20/2009
Last Update Date	:	08/20/2009

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Directions to “BOSTON UNIVERSITY ” Practice Location

Language	Start Address	Practice Location

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