1245773308 NPI number — ASSOCIATED PHYSICIANS OF HARVARD MEDICAL FACULTY PHYSICIANS AT BETH IS

Table of content: (NPI 1245773308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245773308 NPI number — ASSOCIATED PHYSICIANS OF HARVARD MEDICAL FACULTY PHYSICIANS AT BETH IS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATED PHYSICIANS OF HARVARD MEDICAL FACULTY PHYSICIANS AT BETH IS
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:
1245773308
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
375 LONGWOOD AVE
Provider Second Line Business Mailing Address:
SUITE 3B
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02215-5395
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-696-4600
Provider Business Mailing Address Fax Number:
617-754-2371

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
199 REEDSDALE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-696-4600
Provider Business Practice Location Address Fax Number:
617-313-1555
Provider Enumeration Date:
11/22/2016

Additional Information

Authorized Official

Authorized Official Last Name:
KIMBALL
Authorized Official First Name:
ALEXA
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT, CEO
Authorized Official Telephone Number:
617-632-7441

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , 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)





Copyright © 2007-2025 www.npivalidator.com