Healthcare Provider Details

I. General information

NPI: 1174545875
Provider Name (Legal Business Name): MASS GENERAL BRIGHAM COMMUNITY PHYSICIANS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 BEHARRELL ST
CONCORD MA
01742-1739
US

IV. Provider business mailing address

399 REVOLUTION DR STE 1010
SOMERVILLE MA
02145-1582
US

V. Phone/Fax

Practice location:
  • Phone: 781-259-9292
  • Fax: 781-259-0747
Mailing address:
  • Phone: 857-282-2063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number59897
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number59966
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number24941
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number43554
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number75595
License Number StateMA

VIII. Authorized Official

Name: LYNN STOFER
Title or Position: PRESIDENT
Credential:
Phone: 657-282-5157