Provider Demographics
NPI:1417280389
Name:BOSTON UNIVERSITY AFFILIATED PHYSICIANS
Entity Type:Organization
Organization Name:BOSTON UNIVERSITY AFFILIATED PHYSICIANS
Other - Org Name:HEALTH PROMOTION AFFILIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROTONDO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:781-449-2233
Mailing Address - Street 1:661 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-2229
Mailing Address - Country:US
Mailing Address - Phone:781-449-2233
Mailing Address - Fax:781-449-7045
Practice Address - Street 1:661 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-2229
Practice Address - Country:US
Practice Address - Phone:781-449-2233
Practice Address - Fax:781-449-7045
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOSTON UNIVERSITY AFFILATED PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA46024261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care