NPIMap

Organization Active NPI

Beth Israel Deaconess Healthcare

  • Internal Medicine Physician
  • Needham, MA
National Provider Identifier
1144717711
Registry record updated Apr 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
72667 Issued in MA
Legal business name
BETH ISRAEL DEACONESS HEALTHCARE
Practice address
464 Hillside Avenue
Suite 304
Needham, MA 02494
Phone
(617) 754-0549
Fax
(617) 754-0701
NPI assigned
Apr 18, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2018

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

Authorized official

Name
Ms. Michele Susan Sharaf, LICSW
Title
Clinical Social Worker
Phone
(617) 754-0549

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X 72667 MA Primary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X 158258 MA

Addresses

Primary practice location

464 Hillside Avenue
Suite 304
Needham, MA 02494

Mailing address

464 Hillside Avenue
Suite 304
Needham, MA 02494
Phone (617) 754-0549

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1524009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524009600000",
    "number": "1144717711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "464 HILLSIDE AVENUE",
            "address_2": "SUITE 304",
            "city": "NEEDHAM",
            "state": "MA",
            "postal_code": "02494",
            "telephone_number": "617-754-0549",
            "fax_number": "617-754-0701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "464 HILLSIDE AVENUE",
            "address_2": "SUITE 304",
            "city": "NEEDHAM",
            "state": "MA",
            "postal_code": "02494",
            "telephone_number": "617-754-0549",
            "fax_number": "617-754-0701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETH ISRAEL DEACONESS HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-18",
        "last_updated": "2018-04-18",
        "status": "A",
        "authorized_official_last_name": "SHARAF",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "SUSAN",
        "authorized_official_title_or_position": "CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "617-754-0549",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "72667",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "158258",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Needham, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.