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General NPI Number Information
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NPI Number | 1215744057
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Entity Type | Organization
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Legal Business Name | MASS GENERAL BRIGHAM
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 978 WORCESTER ST
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City | WELLESLEY
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State | MA
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Zip | 02482-3709
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Country | US
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Telephone | 617-219-1280
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Fax |
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Provider Business Mailing Address
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Address Line | 168 W 9TH ST APT 1
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City | BOSTON
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State | MA
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Zip | 02127-7720
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Country | US
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Telephone | 339-225-0541
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER, SPORTS MEDICINE
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Name | MR. ANDREW DOLENTE
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Credential |
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Telephone | 617-219-1280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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