Provider Demographics
NPI:1619080355
Name:MEDICAL CARE AFFILIATES
Entity type:Organization
Organization Name:MEDICAL CARE AFFILIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVIN
Authorized Official - Middle Name:EMERSON
Authorized Official - Last Name:DAVIDOFF
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:617-638-9557
Mailing Address - Street 1:660 HARRISON AVE
Mailing Address - Street 2:GAMBRO BUILDINT
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:617-262-1500
Mailing Address - Fax:857-453-4545
Practice Address - Street 1:780 BOYLSTON ST
Practice Address - Street 2:PLAZA ONE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02119
Practice Address - Country:US
Practice Address - Phone:617-262-1500
Practice Address - Fax:617-262-7015
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOSTON UNIVERSITY AFFILIATED PHYSICIANS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-16
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
M13530Medicare UPIN