Provider Demographics
NPI:1649340431
Name:BRIGHAM AND WOMENS HOSPITAL
Entity type:Organization
Organization Name:BRIGHAM AND WOMENS HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMREGENCY DEPT SUPERVISING MD
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:BOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-732-5636
Mailing Address - Street 1:53 BUCKINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-1916
Mailing Address - Country:US
Mailing Address - Phone:617-773-3594
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-5636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA90871282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP46360Medicare UPIN