Provider Demographics
NPI:1164590634
Name:BRIGHAM AND WOMEN'S HOSPITAL
Entity Type:Organization
Organization Name:BRIGHAM AND WOMEN'S HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARA
Authorized Official - Middle Name:SUSANNE
Authorized Official - Last Name:DEJONG
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:617-732-5577
Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:TOWER 2, NUTRITION SERVICES
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:617-732-5577
Mailing Address - Fax:617-278-6929
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:TOWER 2, NUTRITION SERVICES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-5577
Practice Address - Fax:617-278-6929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2417261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service