Provider Demographics
NPI:1053512772
Name:JOSEPH PINES, M.D.,L.L.C
Entity Type:Organization
Organization Name:JOSEPH PINES, M.D.,L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:PINES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-731-0227
Mailing Address - Street 1:1 BROOKLINE PL
Mailing Address - Street 2:SUITE 623
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7224
Mailing Address - Country:US
Mailing Address - Phone:617-731-0227
Mailing Address - Fax:617-734-9274
Practice Address - Street 1:1 BROOKLINE PL
Practice Address - Street 2:SUITE 623
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7224
Practice Address - Country:US
Practice Address - Phone:617-731-0227
Practice Address - Fax:617-734-9274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA28295207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM21445Medicare PIN