Provider Demographics
NPI:1043418882
Name:UNIVERSITY OF MASSACHUSETTS
Entity Type:Organization
Organization Name:UNIVERSITY OF MASSACHUSETTS
Other - Org Name:UMASS DARTMOUTH HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF STUDENT HEALTH SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, ANP-BC
Authorized Official - Phone:508-999-8984
Mailing Address - Street 1:285 OLD WESTPORT ROAD
Mailing Address - Street 2:UMASS DARTMOUTH STUDENT HEALTH SERVICES
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-2300
Mailing Address - Country:US
Mailing Address - Phone:508-999-8982
Mailing Address - Fax:508-999-8985
Practice Address - Street 1:285 OLD WESTPORT ROAD
Practice Address - Street 2:UMASS DARTMOUTH STUDENT HEALTH SERVICES
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-2300
Practice Address - Country:US
Practice Address - Phone:508-999-8982
Practice Address - Fax:508-999-8985
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF MASSACHUSETTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-03
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty