Organization
C H NEUROLOGY FOUNDATION, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELIKI MEDRANO (CLINICAL REIMBURSEMENT AUDITOR)
(617) 919-2107
Entity
Organization
Contact information
Practice address
300 LONGWOOD AVE, FEGAN 11, BOSTON, MA 02115-5724
(617) 355-6391
(617) 919-4097
Mailing address
300 LONGWOOD AVE, FEGAN 11, BOSTON, MA 02115-5724
(617) 355-6391
(617) 919-4097
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M16067
BLUE CROSS BLUE SHIELD
MA
Enumeration date
08/23/2007
Last updated
07/14/2008
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