Provider Demographics
NPI:1609015262
Name:TUFTS MEDICAL CENTER EP LLC
Entity Type:Organization
Organization Name:TUFTS MEDICAL CENTER EP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNEWOLT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-636-4721
Mailing Address - Street 1:800 WASHINGTON ST
Mailing Address - Street 2:BOX 311
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1552
Mailing Address - Country:US
Mailing Address - Phone:617-636-4721
Mailing Address - Fax:
Practice Address - Street 1:800 WASHINGTON ST
Practice Address - Street 2:BOX 311
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1552
Practice Address - Country:US
Practice Address - Phone:617-636-4721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM19758OtherBCBS
MA110086995AMedicaid
MA110086995AMedicaid