Healthcare Provider Details

I. General information

NPI: 1720455603
Provider Name (Legal Business Name): MASSACHUSETTS GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2015
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MAGUIRE RD
LEXINGTON MA
02421-3114
US

IV. Provider business mailing address

1 MAGUIRE RD
LEXINGTON MA
02421-3114
US

V. Phone/Fax

Practice location:
  • Phone: 781-860-1700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number10168
License Number StateMA

VIII. Authorized Official

Name: DR. KIRSTIN BROWN BIRTWELL
Title or Position: ASSISTANT IN PSYCHOLOGY
Credential: PHD
Phone: 781-860-1700