Healthcare Provider Details

I. General information

NPI: 1154267920
Provider Name (Legal Business Name): PROJECT BEACON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/26/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 FRANKLIN ST
BOSTON MA
02110-1301
US

IV. Provider business mailing address

6 LIBERTY SQ # 2719
BOSTON MA
02109-5800
US

V. Phone/Fax

Practice location:
  • Phone: 347-509-7113
  • Fax:
Mailing address:
  • Phone: 347-509-7113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NICOLE TOMPKINS-HUGHES
Title or Position: CHAIR OF THE BOARD OF DIRECTORS
Credential:
Phone: 347-509-7113