Provider Demographics
NPI:1396041356
Name:BOSTON UNIVERSITY GENERAL SURGICAL ASSOCIATES, INC.-QMC
Entity Type:Organization
Organization Name:BOSTON UNIVERSITY GENERAL SURGICAL ASSOCIATES, INC.-QMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MURDOCH
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-638-8606
Mailing Address - Street 1:88 E NEWTON ST
Mailing Address - Street 2:COLLAMORE BLDG, ROOM C500
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2308
Mailing Address - Country:US
Mailing Address - Phone:607-638-8606
Mailing Address - Fax:617-638-8607
Practice Address - Street 1:114 WHITWELL ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-1870
Practice Address - Country:US
Practice Address - Phone:617-376-5681
Practice Address - Fax:617-376-5683
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOSTON UNIVERSITY GENERAL SURGICAL ASSOCIATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110072211AMedicaid
M16109Medicare PIN