Basic Information
| Provider Information | |||||||||
| NPI: | 1427005859 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BOSTON EMERGENCY PHYSICIAN FOUNDATION, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FACULTY PRACTICE FOUNDATION INC BOSTON EMERGENCY PHYSICIAN FND INC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 ALBANY ST FL G | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021193791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174145405 | ||||||||
| FaxNumber: | 6174146031 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 BOSTON MEDICAL CTR PL | ||||||||
| Address2: | BCD 1ST FLOOR | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174145481 | ||||||||
| FaxNumber: | 6174147759 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 01/04/2022 | ||||||||
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| AuthorizedOfficialLastName: | ARBELAEZ | ||||||||
| AuthorizedOfficialFirstName: | CHRISTIAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6174144916 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3114859 | 05 | NH | MEDICAID | 110072263A | 05 | MA | MEDICAID |