Individual
DR. J BENJAMIN CROCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 MERRIMAC ST STE 1000, AMBULATORY PRACTICE OF THE FUTURE, BOSTON, MA 02114-4773
(617) 724-1100
(617) 643-8898
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 724-1100
(617) 643-8898
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
159921
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0114863
—
MA
01
—
159921
TUFTS HEALTH PLAN
MA
01
—
J23402
BCBS MA
MA
Enumeration date
10/25/2005
Last updated
02/07/2014
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