Provider Demographics
NPI:1619160470
Name:BOSTON SPINE AND SCOLIOSIS, PC
Entity Type:Organization
Organization Name:BOSTON SPINE AND SCOLIOSIS, PC
Other - Org Name:MITCHELL HARDENBROOK, MD, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HARDENBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-297-8500
Mailing Address - Street 1:54 HOPEDALE ST STE 3
Mailing Address - Street 2:
Mailing Address - City:HOPEDALE
Mailing Address - State:MA
Mailing Address - Zip Code:01747-1719
Mailing Address - Country:US
Mailing Address - Phone:508-297-8500
Mailing Address - Fax:508-297-8540
Practice Address - Street 1:54 HOPEDALE ST STE 3
Practice Address - Street 2:
Practice Address - City:HOPEDALE
Practice Address - State:MA
Practice Address - Zip Code:01747-1719
Practice Address - Country:US
Practice Address - Phone:508-297-8500
Practice Address - Fax:508-297-8540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty