Provider Demographics
NPI:1528003621
Name:JOSLIN CLINIC INC
Entity Type:Organization
Organization Name:JOSLIN CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP, CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJEEV
Authorized Official - Middle Name:N
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:617-309-2470
Mailing Address - Street 1:1 JOSLIN PLACE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-309-2400
Mailing Address - Fax:617-309-2574
Practice Address - Street 1:1 JOSLIN PL
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5306
Practice Address - Country:US
Practice Address - Phone:617-732-2501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4S33261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9784373Medicaid
MACH7221OtherRR MEDICARE
MACH7221OtherRR MEDICARE
MAM21030Medicare ID - Type Unspecified
MAM20588Medicare ID - Type Unspecified
MAM20590Medicare ID - Type Unspecified
MAM20594Medicare ID - Type Unspecified