Provider Demographics
NPI:1629497417
Name:HARBORMED LLC
Entity Type:Organization
Organization Name:HARBORMED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:MAYER
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-332-4780
Mailing Address - Street 1:17 EDGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-1170
Mailing Address - Country:US
Mailing Address - Phone:617-332-4780
Mailing Address - Fax:815-846-0956
Practice Address - Street 1:21 SCHOOL ST
Practice Address - Street 2:SUITE 1
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-6640
Practice Address - Country:US
Practice Address - Phone:617-332-4780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA33623208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty