Healthcare Provider Details

I. General information

NPI: 1649254491
Provider Name (Legal Business Name): MOUNT AUBURN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2005
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: 617-492-3500
  • Fax: 617-499-5422
Mailing address:
  • Phone: 617-492-3500
  • Fax: 617-499-5422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number2898
License Number StateMA

VIII. Authorized Official

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