Provider Demographics
NPI:1356670293
Name:UMASS MEMORIAL MEDICAL CENTER
Entity Type:Organization
Organization Name:UMASS MEMORIAL MEDICAL CENTER
Other - Org Name:NEW ENGLAND HEMOPHILIA CENTER AT UMASS MEMORIAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRETTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-334-6093
Mailing Address - Street 1:119 BELMONT ST
Mailing Address - Street 2:ATT TERRI RUSSO, SOUTH 1 ADMINISTRATION
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2903
Mailing Address - Country:US
Mailing Address - Phone:508-334-6843
Mailing Address - Fax:508-334-5049
Practice Address - Street 1:119 BELMONT ST
Practice Address - Street 2:NEW ENGLAND HEMOPHILIA CENTER AT UMASS MEMORIAL
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2903
Practice Address - Country:US
Practice Address - Phone:508-334-6047
Practice Address - Fax:508-334-6920
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UMASS MEMORIAL HEALTHCARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-23
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty