Provider Demographics
NPI:1730361197
Name:BOSTON UNIVERSITY GENERAL SURGICAL ASSOCIATES, INC. - PODIATRY
Entity type:Organization
Organization Name:BOSTON UNIVERSITY GENERAL SURGICAL ASSOCIATES, INC. - PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-638-8600
Mailing Address - Street 1:732 HARRISON AVE
Mailing Address - Street 2:PRESTON 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2309
Mailing Address - Country:US
Mailing Address - Phone:617-414-6840
Mailing Address - Fax:617-414-6710
Practice Address - Street 1:732 HARRISON AVE
Practice Address - Street 2:PRESTON 2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2309
Practice Address - Country:US
Practice Address - Phone:617-414-6840
Practice Address - Fax:617-414-6710
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOSTON UNIVERSITY GENERAL SURGICAL ASSOCIATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty