Healthcare Provider Details

I. General information

NPI: 1073947396
Provider Name (Legal Business Name): PRESIDENT AND FELLOWS OF HARVARD COLLEGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2013
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 MOUNT AUBURN ST
CAMBRIDGE MA
02138-4960
US

IV. Provider business mailing address

PO BOX 414361
BOSTON MA
02241-4361
US

V. Phone/Fax

Practice location:
  • Phone: 617-495-5711
  • Fax:
Mailing address:
  • Phone: 617-495-5711
  • Fax: 617-496-0540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number4RA2
License Number StateMA

VIII. Authorized Official

Name: KATHLEEN M COLE
Title or Position: DIRECTOR, REVENUE CYCLE MANAGEMENT
Credential:
Phone: 617-496-9506