Healthcare Provider Details

I. General information

NPI: 1063805687
Provider Name (Legal Business Name): TUFTS MEDICAL CENTER COMMUNITY CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2015
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 WOOD RD SUITE 210
BRAINTREE MA
02184-2413
US

IV. Provider business mailing address

325 WOOD RD SUITE 210
BRAINTREE MA
02184-2413
US

V. Phone/Fax

Practice location:
  • Phone: 781-356-3336
  • Fax:
Mailing address:
  • Phone: 781-356-3336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NATHAN J. GAGNE
Title or Position: CFO
Credential:
Phone: 781-356-3336