Organization
PAI PARTICIPANT MA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILL FORD (DIRECTOR OF CREDENTIALING)
(859) 291-4800
Entity
Organization
Contact information
Practice address
111 ORIENT AVE, EAST BOSTON, MA 02128-1006
(617) 596-2100
Mailing address
PO BOX PO BOX 639676, CINCINNATI, OH 45263-9676
(859) 291-4800
(833) 694-1507
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
08/25/2023
Last updated
08/02/2025
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