Provider Demographics
NPI:1639773039
Name:MASS GENERAL BRIGHAM COMMUNITY PHYSICIANS INC.
Entity Type:Organization
Organization Name:MASS GENERAL BRIGHAM COMMUNITY PHYSICIANS INC.
Other - Org Name:MASS GENERAL BRIGHAM COMMUNITY PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO, SR. VP ADMINISTRATION, & TREAS
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-282-2028
Mailing Address - Street 1:399 REVOLUTION DR STE 1010
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-1444
Mailing Address - Country:US
Mailing Address - Phone:857-282-7643
Mailing Address - Fax:
Practice Address - Street 1:47 MIDDLESEX TPKE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4945
Practice Address - Country:US
Practice Address - Phone:781-653-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-25
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty