Healthcare Provider Details

I. General information

NPI: 1932547155
Provider Name (Legal Business Name): BETH ISRAEL DEACONESS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE
BOSTON MA
02215-5400
US

IV. Provider business mailing address

6 NATE WHIPPLE HWY APT 406
CUMBERLAND RI
02864-1424
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-5864
  • Fax:
Mailing address:
  • Phone: 401-524-6095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number2285030
License Number StateMA

VIII. Authorized Official

Name: RUTH DAMARIS ROY
Title or Position: NEUROSURGERY NP
Credential: ACNP
Phone: 401-524-6095