MEDICARE: GREATER BOSTON ORTHOPAEDIC ASSOCIATES

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	207X00000X	Orthopaedic Surgery Physician	47190	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790730513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER BOSTON ORTHOPAEDIC ASSOCIATES

Provider Business Mailing Address
First Line	:	54 MILLER ST
Second Line	:	4TH FLOOR
City	:	QUINCY
State	:	MA
Zip	:	02169-4725
Country	:	US
Telephone Number	:	617-376-5656
Fax Number	:	617-376-1662

Provider Business Practice Location Address
First Line	:	54 MILLER ST
Second Line	:	4TH FLOOR
City	:	QUINCY
State	:	MA
Zip	:	02169-4725
Country	:	US
Telephone Number	:	617-376-5656
Fax Number	:	617-376-1662

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. LEONID DABUZHSKY
Credential	:	M.D.
Telephone Number	:	617-376-5656

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	03/03/2015

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