Provider Demographics
NPI:1043767577
Name:HARVARD UNIVERSITY
Entity Type:Organization
Organization Name:HARVARD UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM CO-ORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BACKUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-361-2141
Mailing Address - Street 1:1575 TREMONT ST
Mailing Address - Street 2:THE LONGWOOD APT. 701
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02120-1677
Mailing Address - Country:US
Mailing Address - Phone:857-352-7845
Mailing Address - Fax:
Practice Address - Street 1:677 HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6028
Practice Address - Country:US
Practice Address - Phone:603-361-2141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA265320261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine