Provider Demographics
NPI:1962750919
Name:MASSACHUSETTS GENERAL HOSPITAL
Entity type:Organization
Organization Name:MASSACHUSETTS GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:EARNER
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:857-238-5900
Mailing Address - Street 1:79 TREFTON DR
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-2355
Mailing Address - Country:US
Mailing Address - Phone:781-843-8707
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:LUNDER 9
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:857-238-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA202329282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital