Provider Demographics
NPI:1366433104
Name:BOSTON MEDICAL CENTER CORPORATION
Entity type:Organization
Organization Name:BOSTON MEDICAL CENTER CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP & CHIEF PHARMACY OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BHAVESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-638-6789
Mailing Address - Street 1:732 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2309
Mailing Address - Country:US
Mailing Address - Phone:617-638-8130
Mailing Address - Fax:617-638-8125
Practice Address - Street 1:732 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2309
Practice Address - Country:US
Practice Address - Phone:617-638-8130
Practice Address - Fax:617-638-8125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA340333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0447145Medicaid
MADSH723BOtherDSH NUMBER
MA4970810002Medicare NSC