Provider Demographics
NPI:1740374933
Name:BRIGHAM AND WOMEN'S HOSPITAL
Entity type:Organization
Organization Name:BRIGHAM AND WOMEN'S HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERVENTIONAL RADIOLOGY PA
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:617-525-7104
Mailing Address - Street 1:358 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:BOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01719-1112
Mailing Address - Country:US
Mailing Address - Phone:978-263-9341
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:617-525-7104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1595282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital