Provider Demographics
NPI:1518219120
Name:MASSACHUSETTS GENERAL HOSPITAL
Entity Type:Organization
Organization Name:MASSACHUSETTS GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR, INPATIENT PT
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, MS
Authorized Official - Phone:617-724-8579
Mailing Address - Street 1:15 PARKMAN STREET
Mailing Address - Street 2:WANG AMBULATORY CARE CENTER
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-726-3023
Mailing Address - Fax:
Practice Address - Street 1:15 PARKMAN STREET
Practice Address - Street 2:WANG AMBULATORY CARE CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-3023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19901273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit