Basic Information
| Provider Information | |||||||||
| NPI: | 1174821532 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAMBRIDGE FAMILY HEALTH NORTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2067 MASSACHUSETTS AVE | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021401340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175755570 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2067 MASSACHUSETTS AVE | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021401340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175755570 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2011 | ||||||||
| LastUpdateDate: | 03/09/2011 | ||||||||
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| AuthorizedOfficialLastName: | LEGACY | ||||||||
| AuthorizedOfficialFirstName: | LORRI | ||||||||
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| AuthorizedOfficialTitleorPosition: | REGISTERED NURSE | ||||||||
| AuthorizedOfficialTelephone: | 6175755570 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | RN267929 | MA | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.