Provider Demographics
NPI:1235556556
Name:BOSTON MEDICAL GROUP ARIZONA, P.C.
Entity Type:Organization
Organization Name:BOSTON MEDICAL GROUP ARIZONA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:LABARBERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-981-4070
Mailing Address - Street 1:14500 N. NORTHSIGHT BLVD.
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:480-272-8374
Mailing Address - Fax:480-584-4339
Practice Address - Street 1:14500 N. NORTHSIGHT BLVD.
Practice Address - Street 2:SUITE 209
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260
Practice Address - Country:US
Practice Address - Phone:480-272-8374
Practice Address - Fax:480-584-4339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty