Provider Demographics
NPI:1245306976
Name:MASSACHUSETTS GENERAL PHYSICIANS ORGANIZATION, INC
Entity type:Organization
Organization Name:MASSACHUSETTS GENERAL PHYSICIANS ORGANIZATION, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF CONTRACTING
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUBITZKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-726-7853
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-228-4315
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:YAW 10A
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-8868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MASSACHUSETTS GENERAL PHYSICIANS ORGANIZATION, INC,
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-27
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA759007OtherTUFTS