Provider Demographics
NPI:1285653402
Name:BOSTON NEUROLOGICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:BOSTON NEUROLOGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MADDEN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:781-849-9330
Mailing Address - Street 1:340 WOOD RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-2401
Mailing Address - Country:US
Mailing Address - Phone:781-849-9330
Mailing Address - Fax:781-849-9336
Practice Address - Street 1:340 WOOD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2401
Practice Address - Country:US
Practice Address - Phone:781-849-9330
Practice Address - Fax:781-849-9336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3114163Medicaid
MAM17025OtherBLUE CROSS & BLUE SHIELD
MA11373OtherHARVARD PILGRIM HEALTH
MA449251OtherAETNA US HEALTH CARE
MA607607OtherTUFTS HEALTH PLAN
MA11373OtherHARVARD PILGRIM HEALTH