Healthcare Provider Details

I. General information

NPI: 1932367562
Provider Name (Legal Business Name): JONATHAN SAMUEL HAUSMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE BETH ISRAEL DEACONESS MEDICAL CENT
BOSTON MA
02215-5400
US

IV. Provider business mailing address

110 FRANCIS ST SUITE 4B
BOSTON MA
02215-5501
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-7000
  • Fax:
Mailing address:
  • Phone: 617-632-8658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number248865
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number248865
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number248865
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number248865
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: