Provider Demographics
NPI:1750593034
Name:TUFTS-NEW ENGLAND MEDICAL CENTER
Entity type:Organization
Organization Name:TUFTS-NEW ENGLAND MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGERY RESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GHADA
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-MUBARAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-636-5891
Mailing Address - Street 1:55 S HUNTINGTON AVE
Mailing Address - Street 2:APARTMENT 102
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4734
Mailing Address - Country:US
Mailing Address - Phone:703-477-6780
Mailing Address - Fax:
Practice Address - Street 1:55 S HUNTINGTON AVE
Practice Address - Street 2:APARTMENT 102
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-4734
Practice Address - Country:US
Practice Address - Phone:703-477-6780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229707282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital