Provider Demographics
NPI:1578528949
Name:ORTHOPAEDIC CLINICAL ASSOC INC.
Entity Type:Organization
Organization Name:ORTHOPAEDIC CLINICAL ASSOC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BIERBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-754-6742
Mailing Address - Street 1:91 PARKER HILL AVE
Mailing Address - Street 2:
Mailing Address - City:ROXBURY CROSSING
Mailing Address - State:MA
Mailing Address - Zip Code:02120-3215
Mailing Address - Country:US
Mailing Address - Phone:617-754-6742
Mailing Address - Fax:617-754-6443
Practice Address - Street 1:91 PARKER HILL AVE
Practice Address - Street 2:
Practice Address - City:ROXBURY CROSSING
Practice Address - State:MA
Practice Address - Zip Code:02120-3215
Practice Address - Country:US
Practice Address - Phone:617-754-6742
Practice Address - Fax:617-754-6443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9731393Medicaid
MAM12087Medicare PIN