Healthcare Provider Details

I. General information

NPI: 1649111634
Provider Name (Legal Business Name): MASSACHUSETTS GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PARKMAN ST
BOSTON MA
02114-3117
US

IV. Provider business mailing address

15 PARKMAN ST
BOSTON MA
02114-3117
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-9550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN FREDERIKS
Title or Position: RESIDENT
Credential: MD
Phone: 617-726-9550