Provider Demographics
NPI:1841495116
Name:BORIS KARPOVSKY, M.D., LLC
Entity type:Organization
Organization Name:BORIS KARPOVSKY, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KARPOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-926-5268
Mailing Address - Street 1:199 COOLIDGE AVE
Mailing Address - Street 2:UNIT 313
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-1557
Mailing Address - Country:US
Mailing Address - Phone:617-926-5268
Mailing Address - Fax:
Practice Address - Street 1:280 WASHINGTON ST
Practice Address - Street 2:SUITE 304
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3511
Practice Address - Country:US
Practice Address - Phone:617-789-5333
Practice Address - Fax:617-789-4457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA43860207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ10609OtherBCBS OF MASS
MA646734OtherHARVARD PILGRIM HEALTH
MA3073424Medicaid
J10609Medicare ID - Type Unspecified
MA3073424Medicaid