Provider Demographics
NPI:1396855722
Name:MT AUBURN PROFESSIONAL SERVICES INC
Entity Type:Organization
Organization Name:MT AUBURN PROFESSIONAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KLINGSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-673-1796
Mailing Address - Street 1:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-0419
Mailing Address - Country:US
Mailing Address - Phone:978-658-5577
Mailing Address - Fax:978-658-5587
Practice Address - Street 1:725 CONCORD AVE
Practice Address - Street 2:SUITE 2000
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1040
Practice Address - Country:US
Practice Address - Phone:978-658-5577
Practice Address - Fax:978-658-5587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM16405OtherBCBS
MA9782206Medicaid
MA9782206Medicaid