Provider Demographics
NPI:1093867863
Name:BOWDOIN STREET HEALTH CENETER
Entity Type:Organization
Organization Name:BOWDOIN STREET HEALTH CENETER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARGULES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-754-0200
Mailing Address - Street 1:230 BOWDOIN ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-1817
Mailing Address - Country:US
Mailing Address - Phone:617-754-0100
Mailing Address - Fax:617-754-0230
Practice Address - Street 1:230 BOWDOIN ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-1817
Practice Address - Country:US
Practice Address - Phone:617-754-0100
Practice Address - Fax:617-754-0230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110834261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP22863Medicare ID - Type Unspecified