=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639494800
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAMBRIDGE HEALTH ALLIANCE SOMERVILLE HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2010
-----------------------------------------------------
Last Update Date | 03/31/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 230 HIGHLAND AVE
-----------------------------------------------------
City | SOMERVILLE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02143-1408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-591-4460
-----------------------------------------------------
Fax | 617-591-4566
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 230 HIGHLAND AVE
-----------------------------------------------------
City | SOMERVILLE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02143-1408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-591-4460
-----------------------------------------------------
Fax | 617-591-4566
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | STAFF
-----------------------------------------------------
Name | MRS. ANDREA T LYNCH
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 617-591-4460
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0800X
-----------------------------------------------------
Taxonomy Name | Endoscopy Clinic/Center
-----------------------------------------------------
License Number | 212631
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------