| Boston Food Allergy Center Llc | |
|
65 Harrison Ave Ste 201 Boston MA 02111-1924 | |
| (617) 636-8858 | |
| (617) 636-8826 |
| Full Name | Boston Food Allergy Center Llc |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 65 Harrison Ave Ste 201, Boston, Massachusetts |
| Authorized Official Name and Position | Shaun White (CREDENTIALING MANAGER) |
| Authorized Official Contact | 5022449859 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Boston Food Allergy Center Llc 1 Nassau Street Unit 1906 Boston MA 02111-1587 Ph: (617) 636-8858 | Boston Food Allergy Center Llc 65 Harrison Ave Ste 201 Boston MA 02111-1924 Ph: (617) 636-8858 |
| NPI Number | 1386019503 |
|---|---|
| Provider Enumeration Date | 12/14/2015 |
| Last Update Date | 07/18/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386019503 | NPI | - | NPPES |
| 110085164A | Medicaid | MA | |
| 230907 | Other | MA | STATE LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | 230907 (Massachusetts) | Primary |
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