Provider Demographics
NPI:1982080537
Name:BOSTON UROGYN
Entity Type:Organization
Organization Name:BOSTON UROGYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MORSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-340-6446
Mailing Address - Street 1:70 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-2135
Mailing Address - Country:US
Mailing Address - Phone:617-340-6446
Mailing Address - Fax:617-674-3440
Practice Address - Street 1:70 WALNUT ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2135
Practice Address - Country:US
Practice Address - Phone:617-340-6446
Practice Address - Fax:617-674-3440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204833261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAG48278Medicare UPIN