Provider Demographics
NPI:1063431492
Name:BOSTON PUBLIC HEALTH COMMISSION
Entity type:Organization
Organization Name:BOSTON PUBLIC HEALTH COMMISSION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BISOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OJIKUTU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-534-5264
Mailing Address - Street 1:1010 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2600
Mailing Address - Country:US
Mailing Address - Phone:617-534-4222
Mailing Address - Fax:
Practice Address - Street 1:774 ALBANY ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2520
Practice Address - Country:US
Practice Address - Phone:617-534-4212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0666251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA001542402OtherMEDICARE PTAN
MA110025617/BMedicaid