Provider Demographics
NPI:1063459568
Name:BOSTON UNIVERSITY OBSTETRICS AND GYNECOLOGY FOUNDATION, INC.
Entity Type:Organization
Organization Name:BOSTON UNIVERSITY OBSTETRICS AND GYNECOLOGY FOUNDATION, INC.
Other - Org Name:FACULTY PRACTICE FOUNDATION INC BOSTON UNIV OBSTETRICS & GYN FNDN I
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AVIVA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE-PARRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-414-5197
Mailing Address - Street 1:960 MASSACHUSETTS AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 BOSTON MEDICAL CTR PL
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2908
Practice Address - Country:US
Practice Address - Phone:617-414-2000
Practice Address - Fax:617-414-5798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110071404AMedicaid
NH3115094Medicaid