Back Bay MD LLC
Organization Active NPI Clinic/Center · Malden, MA
NPI 1972460244 · NPPES record last updated Jan 7, 2026
Key facts
- NPI
- 1972460244
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- BACK BAY MD LLC
- Practice address
- 578 Main St Unit B5
Malden, MA 02148-4094 - Phone
- (857) 200-8997
- NPI assigned
- Jan 7, 2026
- Organization subpart
- No
Authorized official
- Name
- Dr. Luis Henkel, MD
- Title
- Owner and Medical Director
- Phone
- (857) 200-8997
Practitioners 1
-
Luis Marcelo Henkel, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 22D2309338 | Back Bay MD, LLC | Provider-performed microscopy | Aug 12, 2026 |
National Provider Directory
Locations
578 Main St
Ste B5
Malden, MA 02148
Phone (857) 200-8997
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Yes |
Addresses
Primary practice location
578 Main St Unit B5
Malden, MA 02148-4094
Mailing address
578 Main St Unit B5
Malden, MA 02148-4094
Phone (857) 200-8997
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All providers in Malden, MA · Clinic/Center in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 7, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.