Provider Demographics
NPI:1154852960
Name:BOSTON UNIVERSITY MEDICAL CENTER
Entity Type:Organization
Organization Name:BOSTON UNIVERSITY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ATAKLTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:929-343-1860
Mailing Address - Street 1:704 ENFIELD ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-1113
Mailing Address - Country:US
Mailing Address - Phone:929-343-1860
Mailing Address - Fax:
Practice Address - Street 1:725 ALBANY ST # 56
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2526
Practice Address - Country:US
Practice Address - Phone:617-414-5951
Practice Address - Fax:617-414-9251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital