1639773039 NPI number — MASS GENERAL BRIGHAM COMMUNITY PHYSICIANS INC.

Table of content: (NPI 1639773039)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639773039 NPI number — MASS GENERAL BRIGHAM COMMUNITY PHYSICIANS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MASS GENERAL BRIGHAM COMMUNITY PHYSICIANS 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:
1639773039
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
399 REVOLUTION DR STE 1010
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:
02145-1444
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
857-282-7643
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
47 MIDDLESEX TPKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01803-4945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-653-0100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/25/2020

Additional Information

Authorized Official

Authorized Official Last Name:
CONNOLLY
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CFO, SR. VP ADMINISTRATION, & TREAS
Authorized Official Telephone Number:
857-282-2028

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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