Provider Demographics
NPI:1982937090
Name:CAMBRIDGE PUBLIC HEALTH COMMISSION/DBA/CAMBRIDGE HEALTH ALLIANCE
Entity Type:Organization
Organization Name:CAMBRIDGE PUBLIC HEALTH COMMISSION/DBA/CAMBRIDGE HEALTH ALLIANCE
Other - Org Name:CHAPO
Other - Org Type:Other Name
Authorized Official - Title/Position:CHAPO CAO
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:J
Authorized Official - Last Name:PORELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-499-6621
Mailing Address - Street 1:1493 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1047
Mailing Address - Country:US
Mailing Address - Phone:617-665-1000
Mailing Address - Fax:
Practice Address - Street 1:1493 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1047
Practice Address - Country:US
Practice Address - Phone:617-665-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN PROCESSOtherBCBS NON PCHI GROUP