Provider Demographics
NPI:1891909917
Name:LAURENT C. DELLI-BOVI, MD
Entity Type:Organization
Organization Name:LAURENT C. DELLI-BOVI, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-277-1774
Mailing Address - Street 1:822 BOYLSTON ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2595
Mailing Address - Country:US
Mailing Address - Phone:617-277-1774
Mailing Address - Fax:617-277-3248
Practice Address - Street 1:822 BOYLSTON ST
Practice Address - Street 2:SUITE 109
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2595
Practice Address - Country:US
Practice Address - Phone:617-277-1774
Practice Address - Fax:617-277-3248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0184811Medicaid
MA0184811Medicaid