Provider Demographics
NPI:1427005859
Name:BOSTON EMERGENCY PHYSICIAN FOUNDATION, INC.
Entity Type:Organization
Organization Name:BOSTON EMERGENCY PHYSICIAN FOUNDATION, INC.
Other - Org Name:FACULTY PRACTICE FOUNDATION INC BOSTON EMERGENCY PHYSICIAN FND INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARBELAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-414-4916
Mailing Address - Street 1:960 MASSACHUSETTS AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 BOSTON MEDICAL CTR PL
Practice Address - Street 2:BCD 1ST FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2908
Practice Address - Country:US
Practice Address - Phone:617-414-5481
Practice Address - Fax:617-414-7759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3114859Medicaid
MA110072263AMedicaid
MA110072263AMedicaid
MA607107OtherTUFTS
MAM16244OtherBCBS
MA607107OtherTUFTS
MA110072263AMedicaid