Basic Information
| Provider Information | |||||||||
| NPI: | 1942691803 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MASSACHUSETTS GENERAL PHYSICIANS ORGANIZATION, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9142 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTOWN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021299142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177263884 | ||||||||
| FaxNumber: | 6176437941 | ||||||||
| Practice Location | |||||||||
| Address1: | 52 SECOND AVE STE 1150 | ||||||||
| Address2: | |||||||||
| City: | WALTHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024511129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814874082 | ||||||||
| FaxNumber: | 7814874003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2015 | ||||||||
| LastUpdateDate: | 10/25/2022 | ||||||||
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| AuthorizedOfficialLastName: | MULCAHY | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | ROBERT | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSOCIATE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6177249245 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | MA | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 110000037C | 05 | MA | MEDICAID |