Provider Demographics
NPI:1164498796
Name:GREATER BOSTON GASTROENTEROLOGY
Entity Type:Organization
Organization Name:GREATER BOSTON GASTROENTEROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-620-9200
Mailing Address - Street 1:475 FRANKLIN ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6264
Mailing Address - Country:US
Mailing Address - Phone:508-620-9200
Mailing Address - Fax:508-620-6483
Practice Address - Street 1:475 FRANKLIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6264
Practice Address - Country:US
Practice Address - Phone:508-620-9200
Practice Address - Fax:508-620-6483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty