Healthcare Provider Details

I. General information

NPI: 1518886175
Provider Name (Legal Business Name): THE COMMONWEALTH OF MASSACHUSETTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NASHUA STREET
BOSTON MA
02114
US

IV. Provider business mailing address

200 NASHUA STREET
BOSTON MA
02114
US

V. Phone/Fax

Practice location:
  • Phone: 617-635-1100
  • Fax:
Mailing address:
  • Phone: 617-635-1100
  • Fax: 617-704-6752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. CINDYLOU LYONS
Title or Position: DIRECTOR OF MEDICAL SERVICES
Credential: RN
Phone: 617-635-1100