Organization
EVANS MEDICAL FOUNDATION, INC.
Active
Other names
Faculty Practice Foundation Inc Evans Medical Foundation Inc, Boston University Internal Medicine Associates
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSHRUT S. WAIKAR MD (INTERIM PRESIDENT)
(617) 414-8680
Entity
Organization
Contact information
Practice address
1 BOSTON MEDICAL CTR PL, BOSTON, MA 02118-2908
(617) 358-3510
Mailing address
960 MASSACHUSETTS AVE, FL 2, BOSTON, MA 02118-2690
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
207RH0003X
Hematology & Oncology Physician
—
—
207RI0200X
Infectious Disease Physician
—
—
207RN0300X
Nephrology Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207RR0500X
Rheumatology Physician
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110056578E
—
MA
05
—
3089030
—
NH
Enumeration date
05/31/2006
Last updated
06/10/2024
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