Organization
BOSTON SPINE TEACHING AND RESEARCH FOUNDATION INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT JUDE BANCO M.D. (EXECUTIVE DIRECTOR)
(617) 219-6300
Entity
Organization
Contact information
Practice address
299 WASHINGTON STREET, NEWTON, MA 02458-1612
(617) 219-6300
(617) 219-6366
Mailing address
P.O. BOX 4110, DEPARTMENT 3110, WOBURN, MA 01888-4110
(781) 619-0173
(781) 551-5888
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
59668
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M19066
BCBS MA
MA
Enumeration date
05/24/2006
Last updated
03/09/2015
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