Healthcare Provider Details

I. General information

NPI: 1821141649
Provider Name (Legal Business Name): MASSACHUSETTS GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST SUITE 805 WANG
BOSTON MA
02114-2621
US

IV. Provider business mailing address

55 FRUIT ST CPZ-175, SUITE 300
BOSTON MA
02114-2621
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-6124
  • Fax: 617-726-2777
Mailing address:
  • Phone: 617-724-6352
  • Fax: 617-643-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number176684
License Number StateMA

VIII. Authorized Official

Name: KAREN FURIE
Title or Position: DIRECTOR, STROKE SERVICE
Credential: MD
Phone: 617-726-2941