Provider Demographics
NPI:1669658712
Name:TUFTS UNIVERSITY HEALTH SERVICE
Entity Type:Organization
Organization Name:TUFTS UNIVERSITY HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAGGIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-627-3350
Mailing Address - Street 1:124 PROFESSORS ROW
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-5816
Mailing Address - Country:US
Mailing Address - Phone:617-627-3350
Mailing Address - Fax:617-627-3592
Practice Address - Street 1:124 PROFESSORS ROW
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-5816
Practice Address - Country:US
Practice Address - Phone:617-627-3350
Practice Address - Fax:617-627-3592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service