1285803213 NPI number — MT AUBURN HOSPITAL DEPT OF PSYCHIATRY

Table of content: (NPI 1285803213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285803213 NPI number — MT AUBURN HOSPITAL DEPT OF PSYCHIATRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MT AUBURN HOSPITAL DEPT OF PSYCHIATRY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285803213
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 ARSENAL MARKET PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERTOWN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02472-5018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-673-1851
Provider Business Mailing Address Fax Number:
617-499-5579

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 MOUNT AUBURN ST
Provider Second Line Business Practice Location Address:
CLARK 1
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02138-5502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-499-5054
Provider Business Practice Location Address Fax Number:
617-499-5065
Provider Enumeration Date:
02/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PALUMBO
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
617-499-5599

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X , with the licence number:  2898 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 702043 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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