Provider Demographics
NPI:1902001886
Name:LONGFELLOW PRIMARY CARE, PC
Entity Type:Organization
Organization Name:LONGFELLOW PRIMARY CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAFT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-492-4545
Mailing Address - Street 1:625 MOUNT AUBURN ST
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4555
Mailing Address - Country:US
Mailing Address - Phone:617-492-4545
Mailing Address - Fax:617-492-4559
Practice Address - Street 1:625 MOUNT AUBURN ST
Practice Address - Street 2:SUITE 101A
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4555
Practice Address - Country:US
Practice Address - Phone:617-492-4545
Practice Address - Fax:617-492-4559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA70493207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAF0447Medicare UPIN
MA9701451Medicaid