Provider Demographics
NPI:1457554727
Name:BONEGUARD ORTHOPEDICS, P.C.
Entity Type:Organization
Organization Name:BONEGUARD ORTHOPEDICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:OLAREWAJU
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:OLADIPO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-961-6784
Mailing Address - Street 1:999 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-3072
Mailing Address - Country:US
Mailing Address - Phone:781-961-6784
Mailing Address - Fax:781-961-1127
Practice Address - Street 1:999 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-3072
Practice Address - Country:US
Practice Address - Phone:781-961-6784
Practice Address - Fax:781-961-1127
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BONEGUARD ORTHOPEDICS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-06
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151848207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3169740Medicaid
MAA21961Medicare ID - Type Unspecified
MAM2104601Medicare PIN
MAG38644Medicare UPIN