Provider Demographics
NPI:1184613721
Name:MASSACHUSETTS GENERAL HOSPITAL
Entity type:Organization
Organization Name:MASSACHUSETTS GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR. CARDIAC & VASC. INVASIVE SVCS
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-724-1935
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:CARDIOLOGY, GRB 800, MS 843
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-724-1935
Mailing Address - Fax:617-726-3971
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:CARDIOLOGY, GRB 800, MS 843
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-1935
Practice Address - Fax:617-726-3971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79142282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ08828Medicare ID - Type Unspecified
MAE15237Medicare UPIN