Provider Demographics
NPI:1013921790
Name:MT AUBURN PROFESSIONAL SERVICES
Entity Type:Organization
Organization Name:MT AUBURN PROFESSIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-245-6238
Mailing Address - Street 1:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-0419
Mailing Address - Country:US
Mailing Address - Phone:978-658-5577
Mailing Address - Fax:978-658-5587
Practice Address - Street 1:20 HOLLAND ST
Practice Address - Street 2:SUITE 407
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2700
Practice Address - Country:US
Practice Address - Phone:978-658-5577
Practice Address - Fax:978-658-5587
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MT AUBURN PROFESSIONAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-28
Last Update Date:2024-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty