Provider Demographics
NPI:1346381811
Name:MEDICAL ASSOCIATES OF GREATER BOSTON
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES OF GREATER BOSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:STACEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-820-8383
Mailing Address - Street 1:307 W CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3719
Mailing Address - Country:US
Mailing Address - Phone:508-820-8383
Mailing Address - Fax:508-820-0250
Practice Address - Street 1:307 W CENTRAL ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-3719
Practice Address - Country:US
Practice Address - Phone:508-820-8383
Practice Address - Fax:508-820-0250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9738436Medicaid
MAM18850OtherBLUE CROSS GROUP NUMBER
MA9738436Medicaid