# BACK BAY MD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972460244
- **Authorized official:** DR. LUIS HENKEL MD (OWNER AND MEDICAL DIRECTOR)
- **Authorized official phone:** (857) 200-8997

## Contact information

- **Practice address:** 578 MAIN ST UNIT B5, MALDEN, MA 02148-4094
- **Practice address phone:** (857) 200-8997
- **Mailing address:** 578 MAIN ST UNIT B5, MALDEN, MA 02148-4094
- **Mailing address phone:** (857) 200-8997

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/07/2026
- **Last updated:** 01/07/2026