Provider Demographics
NPI:1437196359
Name:MEDICAL CARE OF BOSTON MANAGEMENT CORPORATION
Entity Type:Organization
Organization Name:MEDICAL CARE OF BOSTON MANAGEMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHRISTOFORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-754-0745
Mailing Address - Street 1:400 BLUE HILL DR
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2164
Mailing Address - Country:US
Mailing Address - Phone:617-754-1023
Mailing Address - Fax:617-754-1040
Practice Address - Street 1:464 HILLSIDE AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-1227
Practice Address - Country:US
Practice Address - Phone:617-754-0730
Practice Address - Fax:617-754-0731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9780378Medicaid
MAM20311Medicare PIN