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General NPI Number Information
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NPI Number | 1841523842
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Entity Type | Organization
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Legal Business Name | MITRE CORPORATION
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Dates
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Enumeration Date | 09/09/2009
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Last Update Date | 09/11/2009
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Provider Practice Location Address
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Address Line | 202 BURLINGTON RD HEALTH SERVICES S130
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City | BEDFORD
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State | MA
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Zip | 01730-1420
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Country | US
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Telephone | 781-271-3029
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Fax | 781-271-8665
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Provider Business Mailing Address
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Address Line | 202 BURLINGTON RD HEALTH SERVICES S130
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City | BEDFORD
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State | MA
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Zip | 01730-1420
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Country | US
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Telephone | 781-271-3029
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Fax | 781-271-8665
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Authorized Official
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Title or Position | HEALTH AND WELLNESS MANAGER
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Name | MS. JOYCE S. BARTH
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Credential | RN, COHN-S
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Telephone | 781-271-3029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | 22D0670706
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License Number State | MA
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