Organization
GBU UMASS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENISE BONAVITA CPB (VICE PRESIDENT BUSINESS ADMIN)
(781) 337-0201
Entity
Organization
Contact information
Practice address
910 WASHINGTON ST STE 200, DEDHAM, MA 02026-6033
(781) 762-0471
Mailing address
51 MILL ST, BLDG F, SUITE A, HANOVER, MA 02339-6022
(781) 337-0201
Taxonomy
Speciality
Code
Description
License number
State
2085U0001X
Diagnostic Ultrasound Physician
—
—
208800000X
Urology Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
01/29/2025
Last updated
01/29/2025
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