Provider Demographics
NPI:1326403296
Name:METROBOSTON CLINICAL PARTNERS LLC
Entity Type:Organization
Organization Name:METROBOSTON CLINICAL PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:AMSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-721-6552
Mailing Address - Street 1:60 DEDHAM AVE
Mailing Address - Street 2:SUITE #206
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-3061
Mailing Address - Country:US
Mailing Address - Phone:781-444-0900
Mailing Address - Fax:781-444-6209
Practice Address - Street 1:60 DEDHAM AVE
Practice Address - Street 2:SUITE #206
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-3061
Practice Address - Country:US
Practice Address - Phone:781-444-0900
Practice Address - Fax:781-444-6209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA70448261QR1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAE35779Medicare UPIN