Healthcare Provider Details

I. General information

NPI: 1821123860
Provider Name (Legal Business Name): MASSACHUSETTS GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PARKMAN ST WACC 835
BOSTON MA
02114-3117
US

IV. Provider business mailing address

40 PROSPECT AVE
QUINCY MA
02170-3320
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-9234
  • Fax:
Mailing address:
  • Phone: 617-980-9394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number226904
License Number StateMA

VIII. Authorized Official

Name: DR. ALICE FLAHERTY
Title or Position: NEUROLOGIST
Credential: MD
Phone: 617-724-9234