Healthcare Provider Details

I. General information

NPI: 1255308227
Provider Name (Legal Business Name): BRIGHAM & WOMENS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date: 08/16/2006
Reactivation Date: 06/04/2007

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115
US

IV. Provider business mailing address

75 FRANCIS ST
BOSTON MA
02115
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-6974
  • Fax: 617-232-8970
Mailing address:
  • Phone: 617-732-6974
  • Fax: 617-232-8970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MR. ROGER J DESHAIES
Title or Position: SENOIR VP FINANCE
Credential:
Phone: 617-732-7899