Provider Demographics
NPI:1184312738
Name:BID-MILTON PHYSICIAN ASSOCIATES INC
Entity type:Organization
Organization Name:BID-MILTON PHYSICIAN ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHEILAH
Authorized Official - Middle Name:
Authorized Official - Last Name:RANGAVIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-313-1350
Mailing Address - Street 1:199 REEDSDALE RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3926
Mailing Address - Country:US
Mailing Address - Phone:617-313-1440
Mailing Address - Fax:
Practice Address - Street 1:100 HIGHLAND ST STE 126
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3879
Practice Address - Country:US
Practice Address - Phone:617-313-1440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty