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Organization
COMMONWEALTH MEDICINE
Active
Organization
COMMONWEALTH MEDICINE
Active
Parent organization
UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL
Other names
CWM - Vaccine Program
Organization subpart
Yes
Provider details
NPI number
Legal business name
UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL
Authorized official
ROSEMARIE BONAVENTURA (DEPUTY DIRECTOR)
(617) 886-8013
Entity
Organization
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(617) 886-8264
Mailing address
529 MAIN ST FL 3, CHARLESTOWN, MA 02129-1125
(617) 886-8264
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
NULL
261QP0905X
State or Local Public Health Clinic/Center
—
NULL
Other
Enumeration date
06/11/2019
Last updated
06/11/2019
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