Healthcare Provider Details

I. General information

NPI: 1184907859
Provider Name (Legal Business Name): MT AUBURN PROFESSIONAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 05/05/2024
Certification Date: 05/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 CONCORD AVE SUITE 3600
CAMBRIDGE MA
02138-1040
US

IV. Provider business mailing address

725 CONCORD AVE SUITE 3600
CAMBRIDGE MA
02138-1040
US

V. Phone/Fax

Practice location:
  • Phone: 617-499-5644
  • Fax:
Mailing address:
  • Phone: 617-499-5644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

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