Provider Demographics
NPI:1750343208
Name:BURLINGTON OB-GYN ASSOC INC
Entity type:Organization
Organization Name:BURLINGTON OB-GYN ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-272-4667
Mailing Address - Street 1:101 CAMBRIDGE STREET
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803
Mailing Address - Country:US
Mailing Address - Phone:781-272-4667
Mailing Address - Fax:781-270-4196
Practice Address - Street 1:101 CAMBRIDGE STREET
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803
Practice Address - Country:US
Practice Address - Phone:781-272-4667
Practice Address - Fax:781-270-4196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
705594OtherTUFTS
MA9720286Medicaid
M10928OtherBXBS
705594OtherTUFTS
MAM10928Medicare PIN