Provider Demographics
NPI:1316175789
Name:BOSTON MEDICAL CENTER
Entity type:Organization
Organization Name:BOSTON MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE PGY 1 RESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SWAPNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-928-3817
Mailing Address - Street 1:72 E CONCORD ST
Mailing Address - Street 2:BOSTON MEDICAL CENTER INTERNAL MEDICINE RESIDENCY EVANS
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:518-928-3817
Mailing Address - Fax:
Practice Address - Street 1:72 E CONCORD ST
Practice Address - Street 2:BOSTON MEDICAL CENTER INTERNAL MEDICINE RESIDENCY EVANS
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:518-928-3817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA241592282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital