Healthcare Provider Details

I. General information

NPI: 1720486830
Provider Name (Legal Business Name): MASS GENERAL BRIGHAM URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 BEACON ST
BROOKLINE MA
02446-5284
US

IV. Provider business mailing address

399 REVOLUTION DR
SOMERVILLE MA
02145-1484
US

V. Phone/Fax

Practice location:
  • Phone: 617-751-6205
  • Fax: 512-485-7393
Mailing address:
  • Phone: 617-751-6205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NIYUM GANDHI
Title or Position: CFO
Credential:
Phone: 617-278-1085