Provider Demographics
NPI:1174701189
Name:TRUSTEES OF BOSTON UNIVERSITY
Entity type:Organization
Organization Name:TRUSTEES OF BOSTON UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:TOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:617-353-5310
Mailing Address - Street 1:5 CUMMINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-2406
Mailing Address - Country:US
Mailing Address - Phone:617-353-5310
Mailing Address - Fax:617-358-0338
Practice Address - Street 1:24 CUMMINGTON ST
Practice Address - Street 2:ROOM 724
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-2425
Practice Address - Country:US
Practice Address - Phone:617-353-5310
Practice Address - Fax:617-358-0338
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRUSTEES OF BOSTON UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2702291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory