Healthcare Provider Details

I. General information

NPI: 1447446380
Provider Name (Legal Business Name): CAMBRIDGE HEALTH ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 GARLAND ST
EVERETT MA
02149-5066
US

IV. Provider business mailing address

103 GARLAND ST
EVERETT MA
02149-5066
US

V. Phone/Fax

Practice location:
  • Phone: 617-381-7163
  • Fax:
Mailing address:
  • Phone: 617-381-7163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number19915
License Number StateMA

VIII. Authorized Official

Name: DIANE E KOTZ
Title or Position: PHARMACIST
Credential: BS RPH
Phone: 617-381-7063