Healthcare Provider Details

I. General information

NPI: 1558726356
Provider Name (Legal Business Name): BETH ISRAEL DEACONESS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2015
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE SHAPIRO 9 BETH ISRAEL DEACONESS MEDICAL CENTER
BOSTON MA
02215
US

IV. Provider business mailing address

403A NEPONSET ST
NORWOOD MA
02062-4952
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-1901
  • Fax: 617-667-2518
Mailing address:
  • Phone: 781-234-4247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberRN185491
License Number StateMA

VIII. Authorized Official

Name: MS. DANIELLE COUTE MCDONALD
Title or Position: NURSE PRACTITIONER
Credential: ACNP-BC
Phone: 617-667-1901