Basic Information
| Provider Information | |||||||||
| NPI: | 1255574901 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JOSLIN CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 JOSLIN PL | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022155306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177322400 | ||||||||
| FaxNumber: | 6177322547 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 JOSLIN PL | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022155306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177322400 | ||||||||
| FaxNumber: | 6177322547 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2009 | ||||||||
| LastUpdateDate: | 04/10/2009 | ||||||||
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| AuthorizedOfficialLastName: | BENBOW | ||||||||
| AuthorizedOfficialFirstName: | WESLEY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 6172265745 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 1547 | MA | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.