MEDICARE: HARVARD MEDICAL FACULTY PHYS AT BETH ISRAEL DEACONESS MED CTR 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1790113389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARVARD MEDICAL FACULTY PHYS AT BETH ISRAEL DEACONESS MED CTR INC

Provider Business Mailing Address
First Line	:	375 LONGWOOD AVE STE 3
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02215-5395
Country	:	US
Telephone Number	:	617-632-7441
Fax Number	:	617-632-7570

Provider Business Practice Location Address
First Line	:	40 ALLIED DR STE 104
Second Line	:
City	:	DEDHAM
State	:	MA
Zip	:	02026-6146
Country	:	US
Telephone Number	:	617-667-0227
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	DR. ALEXANDRA BOER KIMBALL
Credential	:	MD
Telephone Number	:	617-632-7441

Provider Enumeration Date	:	10/17/2013
Last Update Date	:	12/14/2018

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