Healthcare Provider Details

I. General information

NPI: 1962465500
Provider Name (Legal Business Name): MARTHA'S VINEYARD HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL RD
OAK BLUFFS MA
02557-1406
US

IV. Provider business mailing address

1 HOSPITAL RD
OAK BLUFFS MA
02557-1406
US

V. Phone/Fax

Practice location:
  • Phone: 508-684-4500
  • Fax: 508-684-4502
Mailing address:
  • Phone: 508-684-4500
  • Fax: 508-684-4502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateMA
# 6
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateMA

VIII. Authorized Official

Name: ELIZABETH J GANEM
Title or Position: CFO
Credential: CFO
Phone: 508-684-4587