Provider Demographics
NPI:1841523842
Name:MITRE CORPORATION
Entity type:Organization
Organization Name:MITRE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH AND WELLNESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BARTH
Authorized Official - Suffix:
Authorized Official - Credentials:RN, COHN-S
Authorized Official - Phone:781-271-3029
Mailing Address - Street 1:202 BURLINGTON RD
Mailing Address - Street 2:HEALTH SERVICES S130
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1420
Mailing Address - Country:US
Mailing Address - Phone:781-271-3029
Mailing Address - Fax:781-271-8665
Practice Address - Street 1:202 BURLINGTON RD
Practice Address - Street 2:HEALTH SERVICES S130
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1420
Practice Address - Country:US
Practice Address - Phone:781-271-3029
Practice Address - Fax:781-271-8665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22D0670706261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine