NPIMap

Organization Active NPI

Mass General Brigham Medical Group Northern Massachusetts Inc

Doing business as MGB Pathology - PMA Lab

  • Clinical Medical Laboratory
  • Haverhill, MA
National Provider Identifier
1033066972
Registry record updated Mar 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
MASS GENERAL BRIGHAM MEDICAL GROUP NORTHERN MASSACHUSETTS INC
Doing business as
MGB Pathology - PMA Lab
Practice address
1 Park Way
3Rd FL
Haverhill, MA 01830-6220
Phone
(978) 521-3200
NPI assigned
Mar 11, 2026
Last updated
Mar 27, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joanna Hazell
Title
Director, Rco Provider Enrollment
Phone
(781) 254-4854

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

1 Park Way
3Rd FL
Haverhill, MA 01830-6220

Mailing address

399 Revolution Dr Ste 580
Somerville, MA 02145-1572
Phone (781) 254-4865

Other names 1

  • MGB Pathology - PMA Lab Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260501000659 MA Part B Supplier - Independent Clinical Laboratory 3577467224 Practice locations: Haverhill, MA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
CPSC-the Family Doctors3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1 Parkway
Ste 3
Haverhill, MA 01830
Phone (978) 521-3200

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1773187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1774569600000",
    "number": "1033066972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "399 REVOLUTION DR STE 580",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021451572",
            "telephone_number": "781-254-4865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PARK WAY",
            "address_2": "3RD FL",
            "city": "HAVERHILL",
            "state": "MA",
            "postal_code": "018306220",
            "telephone_number": "978-521-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASS GENERAL BRIGHAM MEDICAL GROUP NORTHERN MASSACHUSETTS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-03-11",
        "last_updated": "2026-03-27",
        "certification_date": "2026-03-27",
        "status": "A",
        "authorized_official_last_name": "HAZELL",
        "authorized_official_first_name": "JOANNA",
        "authorized_official_title_or_position": "DIRECTOR, RCO PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "781-254-4854"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MGB Pathology - PMA Lab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Haverhill, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.