Basic Information
| Provider Information | |||||||||
| NPI: | 1073090692 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREATER BOSTON WELLNESS PRIMARY CARE PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 246 WALNUT ST STE 104 | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024601639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172443322 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 PROVIDENCE HWY | ||||||||
| Address2: | |||||||||
| City: | DEDHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020261881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814610660 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2018 | ||||||||
| LastUpdateDate: | 08/16/2022 | ||||||||
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| AuthorizedOfficialLastName: | TEEHAN | ||||||||
| AuthorizedOfficialFirstName: | DENNIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 7813261464 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083P0500X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Preventive Medicine | Preventive Medicine/Occupational Environmental Medicine |
No ID Information.