Healthcare Provider Details

I. General information

NPI: 1740713288
Provider Name (Legal Business Name): GENERAL HOSPITAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 2ND AVE FL 4
WALTHAM MA
02451-1132
US

IV. Provider business mailing address

40 2ND AVE FL 4
WALTHAM MA
02451-1132
US

V. Phone/Fax

Practice location:
  • Phone: 781-487-4390
  • Fax: 781-487-4391
Mailing address:
  • Phone: 781-487-4390
  • Fax: 781-487-4391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. KAREN M RYLE
Title or Position: DIRECTOR OF OUTPATIENT PHARMACY
Credential: MS RPH
Phone: 617-724-9154