Healthcare Provider Details

I. General information

NPI: 1508963901
Provider Name (Legal Business Name): HARVARD MEDICAL FACULTY PHYS AT BETH ISRAEL DEACONESS MED CTR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE
BOSTON MA
02215
US

IV. Provider business mailing address

375 LONGWOOD AVE STE 3
BOSTON MA
02215-5395
US

V. Phone/Fax

Practice location:
  • Phone: 617-754-2339
  • Fax:
Mailing address:
  • Phone: 617-632-7441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRA BOER KIMBALL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 617-632-7441