MEDICARE: BOSTON CHILDRENS HEART FOUNDATION INC

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number State
1	2085P0229X	Pediatric Radiology Physician
2	2080P0203X	Pediatric Critical Care Medicine Physician
3	363LP0200X	Pediatric Nurse Practitioner
4	103T00000X	Psychologist
5	363L00000X	Nurse Practitioner
6	103TC2200X	Clinical Child & Adolescent Psychologist
7	207RC0001X	Clinical Cardiac Electrophysiology Physician
8	207RC0000X	Cardiovascular Disease Physician
9	103TC0700X	Clinical Psychologist
10	363LF0000X	Family Nurse Practitioner
11	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
12	363A00000X	Physician Assistant
13	2080P0202X	Pediatric Cardiology Physician	MA

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

NPI Number	:	1982680922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOSTON CHILDRENS HEART FOUNDATION INC

Provider Business Mailing Address
First Line	:	PO BOX 845628
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02284-5628
Country	:	US
Telephone Number	:	800-927-0002
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 LONGWOOD AVE
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02115-5724
Country	:	US
Telephone Number	:	617-355-6793
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OF CARDIOLOGY
Name	:	TAL GEVA
Credential	:	MD
Telephone Number	:	617-355-6000

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	02/25/2026

75 FRANCIS STREET , BRIGHAM INTERNAL MEDICARE ASSOCIATES
BOSTON, MA
02115

Practice Phone: 617-732-6049
Practice Fax: 617-264-5202