Provider Demographics
NPI:1942405782
Name:PERSONAL PHYSICIANS HEALTHCARE PC
Entity Type:Organization
Organization Name:PERSONAL PHYSICIANS HEALTHCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:PIVOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-731-0058
Mailing Address - Street 1:1244 BOYLSTON ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2116
Mailing Address - Country:US
Mailing Address - Phone:617-731-0058
Mailing Address - Fax:617-731-0825
Practice Address - Street 1:1244 BOYLSTON ST
Practice Address - Street 2:SUITE 306
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2116
Practice Address - Country:US
Practice Address - Phone:617-731-0058
Practice Address - Fax:617-731-0825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM17961OtherBCBS
MA1013905751OtherDR STEVEN R FLIER NPI
MA1699763482OtherDR CORLISS INDIV NPI
MA688727OtherTUFTS
MA1033158563OtherDR BUSCH INDIV NPI
MA1033158563OtherDR BUSCH INDIV NPI