Healthcare Provider Details

I. General information

NPI: 1235594193
Provider Name (Legal Business Name): BRIGHAM AND WOMEN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2015
Last Update Date: 12/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 RICH VALLEY RD
WAYLAND MA
01778-2431
US

IV. Provider business mailing address

23 RICH VALLEY RD
WAYLAND MA
01778-2431
US

V. Phone/Fax

Practice location:
  • Phone: 617-562-7077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberS11593915
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierS11593915
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerMARGARET WEST

VIII. Authorized Official

Name: MARGARET WEST
Title or Position: APRN
Credential:
Phone: 617-562-7077