Organization
BETH ISRAEL DEACONESS MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JULIE MANGANIELLO (BIDPO- ENROLLMENT &CREDENTIALING)
(671) 754-8782
Entity
Organization
Contact information
Practice address
330 BROOKLINE AVE, REN 8, BOSTON, MA 02215-5400
(617) 667-4623
Mailing address
330 BROOKLINE AVE, REN 8, BOSTON, MA 02215-5400
(617) 667-4623
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
106994
MA
Other
Enumeration date
07/05/2006
Last updated
08/22/2020
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