Healthcare Provider Details

I. General information

NPI: 1669658712
Provider Name (Legal Business Name): TUFTS UNIVERSITY HEALTH SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2008
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 PROFESSORS ROW
MEDFORD MA
02155-5816
US

IV. Provider business mailing address

124 PROFESSORS ROW
MEDFORD MA
02155-5816
US

V. Phone/Fax

Practice location:
  • Phone: 617-627-3350
  • Fax: 617-627-3592
Mailing address:
  • Phone: 617-627-3350
  • Fax: 617-627-3592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateMA

VIII. Authorized Official

Name: DR. MARIE CAGGIANO
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 617-627-3350