1942605373 NPI number — MASS GENERAL BRIGHAM MEDICAL GROUP WESTERN MASSACHUSETTS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942605373 NPI number — MASS GENERAL BRIGHAM MEDICAL GROUP WESTERN MASSACHUSETTS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MASS GENERAL BRIGHAM MEDICAL GROUP WESTERN MASSACHUSETTS INC
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:
6
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:
1942605373
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
399 REVOLUTION DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOMERVILLE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02145-1484
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 ATWOOD DR
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
NORTHAMPTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01060-4272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-582-2175
Provider Business Practice Location Address Fax Number:
413-923-9322
Provider Enumeration Date:
10/28/2014

Additional Information

Authorized Official

Authorized Official Last Name:
GAINER
Authorized Official First Name:
LINDSAY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & COO
Authorized Official Telephone Number:
857-282-3914

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , 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)





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