Provider Demographics
NPI:1578648093
Name:USCG ISC BOSTON
Entity Type:Organization
Organization Name:USCG ISC BOSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF, HEALTH SERVICES DIVISION
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-223-3121
Mailing Address - Street 1:427 COMMERCIAL STREET
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109
Mailing Address - Country:US
Mailing Address - Phone:617-223-3121
Mailing Address - Fax:617-223-3038
Practice Address - Street 1:427 COMMERCIAL STREET
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109
Practice Address - Country:US
Practice Address - Phone:617-223-3121
Practice Address - Fax:617-223-3038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient