Provider Demographics
NPI:1316452329
Name:PRIMARY CARE CLINIC BOSTON PC
Entity type:Organization
Organization Name:PRIMARY CARE CLINIC BOSTON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANKUR
Authorized Official - Middle Name:A
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-875-5681
Mailing Address - Street 1:16 HONEYSUCKLE LN
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-3113
Mailing Address - Country:US
Mailing Address - Phone:617-875-5681
Mailing Address - Fax:
Practice Address - Street 1:2100 DORCHESTER AVE BLDG SUITE314
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5615
Practice Address - Country:US
Practice Address - Phone:617-296-0720
Practice Address - Fax:617-296-5166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-13
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty