Healthcare Provider Details

I. General information

NPI: 1972132132
Provider Name (Legal Business Name): BRIGID SHERIDAN MUMFORD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 07/31/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 CONCORD AVE STE 3500
CAMBRIDGE MA
02138-1052
US

IV. Provider business mailing address

330 MT AUBURN ST PARSON 2
CAMBRIDGE MA
02138
US

V. Phone/Fax

Practice location:
  • Phone: 617-354-5452
  • Fax: 617-354-0458
Mailing address:
  • Phone: 617-499-5083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number1017841
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: