Healthcare Provider Details

I. General information

NPI: 1831566132
Provider Name (Legal Business Name): MASSACHUSETTS GENERAL HOSPITAL PHYSICIANS ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2015
Last Update Date: 08/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 BEVERLY RD
CHESTNUT HILL MA
02467-3158
US

IV. Provider business mailing address

249 BEVERLY RD
CHESTNUT HILL MA
02467-3158
US

V. Phone/Fax

Practice location:
  • Phone: 617-327-2903
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number204391
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number204391
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3207391
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: ALEXANDRA KIMBALL
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 617-726-2000