Organization
MGH
Active
Parent organization
MG17508
Other names
Us navy
Organization subpart
Yes
Provider details
NPI number
Legal business name
MG17508
Authorized official
LYNNE BRODSKY MD (MD)
(617) 889-8580
Entity
Organization
Contact information
Practice address
10 TALL TREE DR, BEVERLY, MA 01915-2012
(978) 979-7410
Mailing address
10 TALL TREE DRIVE, BEVERLY, MA 01915
(978) 979-7410
Taxonomy
Speciality
Code
Description
License number
State
281P00000X
Chronic Disease Hospital
179866
MA
302F00000X
Exclusive Provider Organization
Primary
179866
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003910548
NPI
MA
Enumeration date
12/28/2010
Last updated
12/28/2010
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