Provider Demographics
NPI:1740573229
Name:MASSACHUSETTS GENERAL HOSPITAL
Entity Type:Organization
Organization Name:MASSACHUSETTS GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISSA
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:HUBER-ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:617-726-2961
Mailing Address - Street 1:19 LANGLEY RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-2221
Mailing Address - Country:US
Mailing Address - Phone:781-799-4113
Mailing Address - Fax:
Practice Address - Street 1:19 LANGLEY RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-2221
Practice Address - Country:US
Practice Address - Phone:781-799-4113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18408282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital