Provider Demographics
NPI:1548638265
Name:MASS GENERAL BRIGHAM COMMUNITY PHYSICIANS INC.
Entity type:Organization
Organization Name:MASS GENERAL BRIGHAM COMMUNITY PHYSICIANS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO, SVP OF ADMIN & TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-282-2028
Mailing Address - Street 1:399 REVOLUTION DR STE 1010
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-1444
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:137 MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4522
Practice Address - Country:US
Practice Address - Phone:781-395-4909
Practice Address - Fax:781-395-5081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-11
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty