Healthcare Provider Details

I. General information

NPI: 1245306976
Provider Name (Legal Business Name): MASSACHUSETTS GENERAL PHYSICIANS ORGANIZATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 02/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST YAW 10A
BOSTON MA
02114-2621
US

IV. Provider business mailing address

PO BOX 9142
CHARLESTOWN MA
02129-9142
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-8868
  • Fax:
Mailing address:
  • Phone: 617-724-0287
  • Fax: 617-228-4315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. ANNE J. DUBITZKY
Title or Position: VICE PRESIDENT OF CONTRACTING
Credential:
Phone: 617-726-7853