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General NPI Number Information
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NPI Number | 1053463448
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Entity Type | Organization
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Legal Business Name | THE COMMONWEALTH OF MASSACHUSETTS
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 04/05/2023
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Provider Practice Location Address
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Address Line | 305 SOUTH ST
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City | BOSTON
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State | MA
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Zip | 02130-3515
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Country | US
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Telephone | 617-983-6668
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Fax |
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Provider Business Mailing Address
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Address Line | 305 SOUTH ST
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City | BOSTON
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State | MA
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Zip | 02130-3515
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Country | US
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Telephone | 617-983-6668
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Fax |
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Authorized Official
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Title or Position | DEPUTY DIRECTOR
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Name | CECILIA ELIZABETH DUNN
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Credential |
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Telephone | 617-963-6413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | NA
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License Number State | MA
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