Healthcare Provider Details

I. General information

NPI: 1265094122
Provider Name (Legal Business Name): MASS GENERAL BRIGHAM COMMUNITY PHYSICIANS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 STATE ST STE 106
BOSTON MA
02109-2820
US

IV. Provider business mailing address

399 REVOLUTION DR STE 1010
SOMERVILLE MA
02145-1582
US

V. Phone/Fax

Practice location:
  • Phone: 617-903-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LYNN STOFER
Title or Position: PRESIDENT & COO
Credential:
Phone: 617-763-9047