Basic Information
| Provider Information | |||||||||
| NPI: | 1528003621 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOSLIN CLINIC INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 JOSLIN PLACE | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173092400 | ||||||||
| FaxNumber: | 6173092574 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 JOSLIN PL | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022155306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177322501 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 04/15/2021 | ||||||||
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| AuthorizedOfficialLastName: | MEHTA | ||||||||
| AuthorizedOfficialFirstName: | SANJEEV | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | SVP, CHIEF MEDICAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6173092470 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD, MPH | ||||||||
| NPICertificationDate: | 04/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | 4S33 | MA | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
ID Information
| ID | Type | State | Issuer | Description | 9784373 | 05 | MA | MEDICAID | CH7221 | 01 | MA | RR MEDICARE | OTHER |