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General NPI Number Information
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NPI Number | 1679397913
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Entity Type | Organization
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Legal Business Name | HARVARD MEDICAL FACULTY PHYS AT BETH ISRAEL DEACONESS MED CTR INC
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 330 BROOKLINE AVE STE 3
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City | BOSTON
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State | MA
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Zip | 02215-5400
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Country | US
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Telephone | 617-667-2906
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Fax |
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Provider Business Mailing Address
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Address Line | 375 LONGWOOD AVE STE 3
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City | BOSTON
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State | MA
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Zip | 02215-5395
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Country | US
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Telephone | 781-632-7443
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | ALEXANDRA BOER KIMBALL
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Credential | MD
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Telephone | 617-632-7443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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