Provider Demographics
NPI:1689670259
Name:MOUNT AUBURN HOSPITAL
Entity Type:Organization
Organization Name:MOUNT AUBURN HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-499-5654
Mailing Address - Street 1:330 MOUNT AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5502
Mailing Address - Country:US
Mailing Address - Phone:617-492-3500
Mailing Address - Fax:617-499-5422
Practice Address - Street 1:330 MOUNT AUBURN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5502
Practice Address - Country:US
Practice Address - Phone:617-492-3500
Practice Address - Fax:617-499-5422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2898282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2222000230OtherSURG.DAY CARE BLUE CROSS
MA900023OtherHARVARD PILGRIM HEALTH CA
MA1201298Medicaid
MA2222000205OtherPSYCH BLUE CROSS PROV. NU
MA50-40078OtherUNITED HEALTH CARE
MA996324OtherNETWORK HEALTH SERVICES
MA1099876Medicaid
MA0007057OtherNEIGHBORHOOD HEALTH PLAN
MA2222000210OtherOUTPAT.BLUE CROSS PROV.NU
MA900749OtherOUTPAT.TUFTS AFFIL. H.P.
MA0012149OtherAETNA/US HEALTHCARE PROV.
MA2222000201OtherINPAT.BLUE CROSS PROV.NUM
MA245718OtherMAGELLAN OUTPATIENT PSYCH
MA900037OtherINPAT.SECURE HORIZONS PRO
MA1201298Medicaid