Provider Demographics
NPI:1629189014
Name:GASTROENTEROLOGY ASSOCIATES AT FAULKNER LLP
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES AT FAULKNER LLP
Other - Org Name:GASTROENTEROLOGY ASSOCIATES AT FAULKNER LLP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FLANAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-522-9996
Mailing Address - Street 1:1153 CENTRE ST
Mailing Address - Street 2:SUITE 45
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3446
Mailing Address - Country:US
Mailing Address - Phone:617-522-9996
Mailing Address - Fax:617-524-6599
Practice Address - Street 1:1153 CENTRE ST
Practice Address - Street 2:SUITE 45
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-3446
Practice Address - Country:US
Practice Address - Phone:617-522-9996
Practice Address - Fax:617-524-6599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
M11803Medicare PIN