Healthcare Provider Details

I. General information

NPI: 1689607707
Provider Name (Legal Business Name): BETH ISRAEL DEACONESS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 FRANCIS ST SUITE 2G
BOSTON MA
02215-5501
US

IV. Provider business mailing address

96 ARLINGTON RD
CHESTNUT HILL MA
02467-2615
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-9929
  • Fax: 617-632-9917
Mailing address:
  • Phone: 617-383-5653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number220783
License Number StateMA

VIII. Authorized Official

Name: DR. CHRISTOPHER CAMERON BAKER
Title or Position: CHIEF, TRAUMA & CRITICAL CARE
Credential: MD
Phone: 617-632-9929