Healthcare Provider Details

I. General information

NPI: 1932367562
Provider Name (Legal Business Name): JONATHAN SAMUEL HAUSMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 CONCORD AVE APT 9
CAMBRIDGE MA
02138-1360
US

IV. Provider business mailing address

243 CONCORD AVE APT 9
CAMBRIDGE MA
02138-1360
US

V. Phone/Fax

Practice location:
  • Phone: 617-871-0040
  • Fax: 888-531-3853
Mailing address:
  • Phone: 617-871-0040
  • Fax: 888-531-3853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number248865
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number248865
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number248865
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number248865
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: