Basic Information
| Provider Information | |||||||||
| NPI: | 1710125117 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BETH ISRAEL DEACONESS MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1368 COMMONWEALTH AVE APT 24 | ||||||||
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| City: | ALLSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021343610 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 330 BROOKLINE AVE | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022155400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176679600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2009 | ||||||||
| LastUpdateDate: | 01/23/2009 | ||||||||
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| AuthorizedOfficialLastName: | REYNOLDS | ||||||||
| AuthorizedOfficialFirstName: | EILEEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROGRAM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6176679600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 228158 | MA | Y | Hospitals | General Acute Care Hospital |
No ID Information.