Healthcare Provider Details

I. General information

NPI: 1881790020
Provider Name (Legal Business Name): BRIGHAM AND WOMEN'S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS STREET BRIGHAM AND WOMEN'S HOSPITAL
BOSTON MA
02135
US

IV. Provider business mailing address

1419 COMMONWEALTH AVE APT 501
BRIGHTON MA
02135-6249
US

V. Phone/Fax

Practice location:
  • Phone: 617-525-7775
  • Fax:
Mailing address:
  • Phone: 617-783-1695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number1004
License Number StateMA

VIII. Authorized Official

Name: ROBERT BRACH
Title or Position: PHYSICIAN ASSISTANT
Credential: PA-C
Phone: 617-525-7775