Healthcare Provider Details

I. General information

NPI: 1932134707
Provider Name (Legal Business Name): THE MCLEAN HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 10/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MILL ST
BELMONT MA
02478-1041
US

IV. Provider business mailing address

P.O. BOX 5-0408
WOBURN MA
01815-0408
US

V. Phone/Fax

Practice location:
  • Phone: 617-855-3311
  • Fax: 617-855-2366
Mailing address:
  • Phone: 617-724-3371
  • Fax: 617-724-9687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH GOLD
Title or Position: CHIEF MEDICAL OFFICER
Credential: M.D.
Phone: 617-855-2367