MEDICARE: MASS GENERAL BRIGHAM MEDICAL GROUP NORTHERN MASSACHUSETTS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1033066972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASS GENERAL BRIGHAM MEDICAL GROUP NORTHERN MASSACHUSETTS INC

Provider Business Mailing Address
First Line	:	399 REVOLUTION DR STE 580
Second Line	:
City	:	SOMERVILLE
State	:	MA
Zip	:	02145-1572
Country	:	US
Telephone Number	:	781-254-4865
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 PARK WAY
Second Line	:	3RD FL
City	:	HAVERHILL
State	:	MA
Zip	:	01830-6220
Country	:	US
Telephone Number	:	978-521-3200
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, RCO PROVIDER ENROLLMENT
Name	:	JOANNA HAZELL
Credential	:
Telephone Number	:	781-254-4854

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/13/2026

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