Provider Demographics
NPI:1003998477
Name:BOSTON CARDIOVASCULAR ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:BOSTON CARDIOVASCULAR ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:IZZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-735-9200
Mailing Address - Street 1:125 PARKER HILL AVE
Mailing Address - Street 2:STE 500
Mailing Address - City:ROXBURY CROSSING
Mailing Address - State:MA
Mailing Address - Zip Code:02120-2847
Mailing Address - Country:US
Mailing Address - Phone:617-735-9200
Mailing Address - Fax:617-735-9230
Practice Address - Street 1:125 PARKER HILL AVE
Practice Address - Street 2:STE 500
Practice Address - City:ROXBURY CROSSING
Practice Address - State:MA
Practice Address - Zip Code:02120-2847
Practice Address - Country:US
Practice Address - Phone:617-735-9200
Practice Address - Fax:617-735-9230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA690848OtherTUFTS
MA9707727Medicaid
MAM17822OtherBXBS
MAM20982Medicare PIN