Provider Demographics
NPI:1639562903
Name:COMPLETENDOCRINE LLC
Entity Type:Organization
Organization Name:COMPLETENDOCRINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:HADEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-731-3400
Mailing Address - Street 1:200 BOYLSTON ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2012
Mailing Address - Country:US
Mailing Address - Phone:617-467-6672
Mailing Address - Fax:617-566-2224
Practice Address - Street 1:200 BOYLSTON ST
Practice Address - Street 2:SUITE 301
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2012
Practice Address - Country:US
Practice Address - Phone:617-467-6672
Practice Address - Fax:617-566-2224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79778261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G77079Medicare UPIN