Provider Demographics
NPI:1194765438
Name:HARVARD MEDICAL FACULTY PHYS AT BETH ISRAEL DEACONESS MED CTR INC
Entity type:Organization
Organization Name:HARVARD MEDICAL FACULTY PHYS AT BETH ISRAEL DEACONESS MED CTR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF DATA MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-528-2835
Mailing Address - Street 1:330 BROOKLINE AVE
Mailing Address - Street 2:REN-8
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5400
Mailing Address - Country:US
Mailing Address - Phone:617-754-8782
Mailing Address - Fax:617-754-8790
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-754-9600
Practice Address - Fax:617-667-6406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9753389Medicaid
MAM20490Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER