Provider Demographics
NPI:1932547155
Name:BETH ISRAEL DEACONESS HOSPITAL
Entity Type:Organization
Organization Name:BETH ISRAEL DEACONESS HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROSURGERY NP
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:DAMARIS
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:ACNP
Authorized Official - Phone:401-524-6095
Mailing Address - Street 1:6 NATE WHIPPLE HWY APT 406
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-1424
Mailing Address - Country:US
Mailing Address - Phone:401-524-6095
Mailing Address - Fax:
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-5864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-10
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2285030282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access