1457521437 NPI number — PRESIDENT & FELLOWS OF HARVARD COLLEGE

Table of content: (NPI 1457521437)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457521437 NPI number — PRESIDENT & FELLOWS OF HARVARD COLLEGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESIDENT & FELLOWS OF HARVARD COLLEGE
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:
HARVARD UNIVERSITY HEALTH SERVICE PODIATRY
Provider Other Organization Name Type Code:
5
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:
1457521437
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 MOUNT AUBURN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02138-4960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-496-9506
Provider Business Mailing Address Fax Number:
617-495-6059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 MOUNT AUBURN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02138-4960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-496-9506
Provider Business Practice Location Address Fax Number:
617-495-6059
Provider Enumeration Date:
03/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
COLE
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR REVENUE CYCLE MGMT
Authorized Official Telephone Number:
617-496-9506

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , 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: Y77366 . This is a "BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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