Provider Demographics
NPI:1811490790
Name:TRUSTEES OF TUFTS COLLEGE
Entity type:Organization
Organization Name:TRUSTEES OF TUFTS COLLEGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GATELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-636-6505
Mailing Address - Street 1:200 HARRISON AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1836
Mailing Address - Country:US
Mailing Address - Phone:617-636-4021
Mailing Address - Fax:
Practice Address - Street 1:200 HARRISON AVE FL 2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111
Practice Address - Country:US
Practice Address - Phone:617-636-4021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRUSTEES OF TUFTS COLLEGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-16
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH0032PDO261QC1500X
261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health