Healthcare Provider Details

I. General information

NPI: 1205900354
Provider Name (Legal Business Name): BETH ISRAEL DEACONESS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE HEALTHCARE ASSOCIATES, SHAPIRO 6TH FLOOR
BOSTON MA
02215-5400
US

IV. Provider business mailing address

330 BROOKLINE AVE HEALTHCARE ASSOCIATES, SHAPIRO 6TH FLOOR
BOSTON MA
02215-5400
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-9600
  • Fax: 617-667-9620
Mailing address:
  • Phone: 617-667-9600
  • Fax: 617-667-9620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number73356
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number73356
License Number StateMA

VIII. Authorized Official

Name: DR. RUSSELL PHILLIPS
Title or Position: DIVISION CHIEF
Credential: MD
Phone: 617-667-4916