Provider Demographics
NPI:1184867483
Name:BELMONT MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:BELMONT MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNORS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-864-4108
Mailing Address - Street 1:725 CONCORD AVE
Mailing Address - Street 2:SUITE 4100
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1040
Mailing Address - Country:US
Mailing Address - Phone:617-864-4108
Mailing Address - Fax:617-547-5367
Practice Address - Street 1:725 CONCORD AVE
Practice Address - Street 2:SUITE 4100
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1040
Practice Address - Country:US
Practice Address - Phone:617-864-4108
Practice Address - Fax:617-547-5367
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BELMONT MEDICAL ASSOCIATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47577207VG0400X
MA56978207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM12887OtherBLUE CROSS BLUE SHIELD OF MASSACHUSETTS