Healthcare Provider Details

I. General information

NPI: 1457997512
Provider Name (Legal Business Name): HOSPITALIST MEDICINE PHYSICIANS OF MASSACHUSETTS - BROCKTON PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 CENTRE ST
BROCKTON MA
02302-3308
US

IV. Provider business mailing address

1222 DEMONBREUN ST STE 1601
NASHVILLE TN
37203-7092
US

V. Phone/Fax

Practice location:
  • Phone: 253-682-6040
  • Fax:
Mailing address:
  • Phone: 253-682-6040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA FALL
Title or Position: MANAGER
Credential:
Phone: 253-682-6040