Healthcare Provider Details

I. General information

NPI: 1447662036
Provider Name (Legal Business Name): MT AUBURN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2014
Last Update Date: 05/05/2024
Certification Date: 05/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 MOUNT AUBURN ST
CAMBRIDGE MA
02138-5502
US

IV. Provider business mailing address

330 MOUNT AUBURN ST
CAMBRIDGE MA
02138-5502
US

V. Phone/Fax

Practice location:
  • Phone: 617-499-5595
  • Fax: 617-499-5103
Mailing address:
  • Phone: 617-499-5595
  • Fax: 617-499-5103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN SMITH
Title or Position: CFO
Credential:
Phone: 405-245-6238