Basic Information
| Provider Information | |||||||||
| NPI: | 1659436814 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREATER BOSTON INTERNAL MEDICINE, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 PROVIDENCE HWY | ||||||||
| Address2: | |||||||||
| City: | DEDHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020261881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813261464 | ||||||||
| FaxNumber: | 7813262230 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 PROVIDENCE HWY | ||||||||
| Address2: | |||||||||
| City: | DEDHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020261881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813261464 | ||||||||
| FaxNumber: | 7813262230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | IARROBINO | ||||||||
| AuthorizedOfficialFirstName: | AGOSTINO | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7813261464 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.