Basic Information
| Provider Information | |||||||||
| NPI: | 1902071129 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOSTON MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17 MELENDY AVE APT 1 | ||||||||
| Address2: | |||||||||
| City: | WATERTOWN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024724108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4044522968 | ||||||||
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| Practice Location | |||||||||
| Address1: | 830 HARRISON AVE | ||||||||
| Address2: | SUITE 1400 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176388124 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2008 | ||||||||
| LastUpdateDate: | 06/05/2012 | ||||||||
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| AuthorizedOfficialLastName: | GRILLONE | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE CHAIRMAN | ||||||||
| AuthorizedOfficialTelephone: | 6176387934 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
No ID Information.