Healthcare Provider Details

I. General information

NPI: 1215340104
Provider Name (Legal Business Name): MASS GENERAL PHYSICIANS ORG-HEMOPHILIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST YAWKEY, SUITE 7
BOSTON MA
02114-2621
US

IV. Provider business mailing address

PO BOX 9142
CHARLESTOWN MA
02129-9142
US

V. Phone/Fax

Practice location:
  • Phone: 617-643-0310
  • Fax:
Mailing address:
  • Phone: 617-643-0310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GREGORY J PAULY
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 617-724-7713