Provider Demographics
NPI:1053463448
Name:THE COMMONWEALTH OF MASSACHUSETTS
Entity Type:Organization
Organization Name:THE COMMONWEALTH OF MASSACHUSETTS
Other - Org Name:CHILDHOOD LEAD SCREENING LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-963-6413
Mailing Address - Street 1:305 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3515
Mailing Address - Country:US
Mailing Address - Phone:617-983-6668
Mailing Address - Fax:
Practice Address - Street 1:305 SOUTH ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-3515
Practice Address - Country:US
Practice Address - Phone:617-983-6668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE COMMONWEALTH OF MASSACHUSETTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-17
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MANA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
800470OtherHEALTH PILGRIM HEALTH PLA
MA0805998Medicaid
804460OtherTUFTS HEALTH PLAN
BOSTON HEALTHNETOther20611
32545OtherCHILDRENS MEDICAL SECURIT
MA228421OtherBLUE CROSS OF MASS
800470OtherHEALTH PILGRIM HEALTH PLA