Provider Demographics
NPI:1528485828
Name:BOSTON MEDICAL GROUP PENNSYLVANIA, P.C.
Entity type:Organization
Organization Name:BOSTON MEDICAL GROUP PENNSYLVANIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:LABARBERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-981-4070
Mailing Address - Street 1:100 S. BROAD STREET
Mailing Address - Street 2:SUITE 2136
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19110
Mailing Address - Country:US
Mailing Address - Phone:215-972-7090
Mailing Address - Fax:215-972-7097
Practice Address - Street 1:100 S. BROAD STREET
Practice Address - Street 2:SUITE 2136
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19110
Practice Address - Country:US
Practice Address - Phone:215-972-7090
Practice Address - Fax:215-972-7097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty