Organization
BOSTONIVF-CRMI HOLDING, LLC
Active
Parent organization
BOSTON IVF
Organization subpart
Yes
Provider details
NPI number
Legal business name
BOSTON IVF
Authorized official
GAIL K HENDRICKSON (PRACTICE ADMINISTRATOR)
(781) 438-9600
Entity
Organization
Contact information
Practice address
2 MAIN ST, STE 150, STONEHAM, MA 02180-3335
(781) 438-9600
(781) 438-9601
Mailing address
130 SECOND AVE, WALTHAM, MA 02451-1100
(781) 434-6500
(781) 890-8060
Taxonomy
Speciality
Code
Description
License number
State
207VE0102X
Reproductive Endocrinology Physician
Primary
—
—
207VG0400X
Gynecology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285707356
FALLON
MA
01
—
13397
HPHC
MA
01
—
1380826
AETNA
MA
01
—
712663
TUFTS HEALTH PLAN
MA
01
—
99155003
NETWORK HEALTH
MA
01
—
J06571
BCBSMA
MA
01
—
M19275
BCBS INDEMNITY
MA
Enumeration date
10/16/2012
Last updated
10/25/2012
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