Provider Demographics
NPI:1255867487
Name:BOSTON ADVANCED MEDICINE INC
Entity Type:Organization
Organization Name:BOSTON ADVANCED MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTWICKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-895-7903
Mailing Address - Street 1:281 WINTER ST FL 2
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-8740
Mailing Address - Country:US
Mailing Address - Phone:781-895-7900
Mailing Address - Fax:
Practice Address - Street 1:281 WINTER ST FL 2
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-8740
Practice Address - Country:US
Practice Address - Phone:781-895-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-09
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5244291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory