Provider Demographics
NPI:1841360716
Name:CENTER FOR BLISTERING DISEASES, INC
Entity type:Organization
Organization Name:CENTER FOR BLISTERING DISEASES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:RAZZAQUE
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-562-1040
Mailing Address - Street 1:697 CAMBRIDGE ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2897
Mailing Address - Country:US
Mailing Address - Phone:617-562-1040
Mailing Address - Fax:617-562-1047
Practice Address - Street 1:697 CAMBRIDGE ST
Practice Address - Street 2:SUITE 302
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2897
Practice Address - Country:US
Practice Address - Phone:617-562-1040
Practice Address - Fax:617-562-1047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
690849OtherTUFTS SECURE HORIZONS
001620OtherNEIGHBORHOOD HEALTH
CQ80OtherHARVARD PILGRIM HEALTH
59699OtherFALLON HEALTH PLAN
CQ80OtherHPHC FIRST SENIORITY PLAN
3051578OtherAETNA US HEALTHCARE
DA7122OtherRAILROAD MEDICARE PALMETO
M17819OtherBCBS RI
M17819OtherBCBS MA
=========OtherPRIVATE HEALTHCARE SYS
=========OtherGIC INDEMNITY COMM MASS
CQ80OtherHARVARD PILGRIM HEALTH
M17819OtherBCBS RI
CQ80OtherHPHC FIRST SENIORITY PLAN