Basic Information
| Provider Information | |||||||||
| NPI: | 1942619721 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LONGWOOD ACADEMIC PHYSICIANS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 417919 | ||||||||
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| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022417919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176328788 | ||||||||
| FaxNumber: | 6176329150 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 MOUNT AUBURN ST | ||||||||
| Address2: | SUITE 416 | ||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021385502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176328788 | ||||||||
| FaxNumber: | 6176329150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2014 | ||||||||
| LastUpdateDate: | 08/06/2014 | ||||||||
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| AuthorizedOfficialLastName: | ROSENBERG | ||||||||
| AuthorizedOfficialFirstName: | STUART | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6176328788 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery | 2086S0129X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 208600000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.