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Organization
BOSTON FOOD ALLERGY CENTER, STEWARD HEALTHCARE NETWORK
Active
Organization
BOSTON FOOD ALLERGY CENTER, STEWARD HEALTHCARE NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAUN WHITE (CREDENTIALING MANAGER)
(502) 244-9859
Entity
Organization
Contact information
Practice address
65 HARRISON AVE, SUITE 201, BOSTON, MA 02111-1924
(617) 636-8858
(617) 636-8826
Mailing address
1 NASSAU ST, UNIT 1906, BOSTON, MA 02111-1542
(617) 636-8858
(617) 636-8826
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
230907
MA
207RG0100X
Gastroenterology Physician
230907
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110085164A - INDIV
—
MA
05
—
110109748A
—
MA
01
—
230907
PROVIDER LICENSE
MA
Enumeration date
07/27/2016
Last updated
07/27/2016
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