Provider Demographics
NPI:1245658954
Name:BOSTON MEDICAL GROUP, L.L.C.
Entity type:Organization
Organization Name:BOSTON MEDICAL GROUP, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:QUOC
Authorized Official - Middle Name:H
Authorized Official - Last Name:HA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-735-8451
Mailing Address - Street 1:1020 19TH STREET N.W., SUITE 225
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006
Mailing Address - Country:US
Mailing Address - Phone:202-419-1840
Mailing Address - Fax:202-419-1842
Practice Address - Street 1:1020 19TH STREET N.W., SUITE 225
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006
Practice Address - Country:US
Practice Address - Phone:202-419-1840
Practice Address - Fax:202-419-1842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-31
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty