Provider Demographics
NPI:1093273146
Name:CED CLINIC LLC
Entity Type:Organization
Organization Name:CED CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:CAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-500-3595
Mailing Address - Street 1:822 BOYLSTON ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2595
Mailing Address - Country:US
Mailing Address - Phone:617-500-3595
Mailing Address - Fax:617-275-2191
Practice Address - Street 1:822 BOYLSTON ST FL 2
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2595
Practice Address - Country:US
Practice Address - Phone:617-500-3595
Practice Address - Fax:617-275-2191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty