Provider Demographics
NPI:1053783449
Name:BACK BAY ALLERGY ASSOCIATES LLC
Entity type:Organization
Organization Name:BACK BAY ALLERGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:OSTRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-452-4626
Mailing Address - Street 1:77 E MERRIMACK ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1251
Mailing Address - Country:US
Mailing Address - Phone:978-452-4626
Mailing Address - Fax:707-598-0684
Practice Address - Street 1:77 E MERRIMACK ST
Practice Address - Street 2:SUITE 6
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1251
Practice Address - Country:US
Practice Address - Phone:978-452-4626
Practice Address - Fax:707-598-0684
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BACK BAY ALLERGY ASSOCIATES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42186207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty