Healthcare Provider Details

I. General information

NPI: 1548638265
Provider Name (Legal Business Name): MASS GENERAL BRIGHAM COMMUNITY PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 MAIN ST
MEDFORD MA
02155-4522
US

IV. Provider business mailing address

399 REVOLUTION DR STE 1010
SOMERVILLE MA
02145-1444
US

V. Phone/Fax

Practice location:
  • Phone: 781-395-4909
  • Fax: 781-395-5081
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: LYNN STOFER
Title or Position: PRESIDENT & COO
Credential:
Phone: 857-282-5157