NPIMap

Organization Active NPI

Mt Auburn Professional Service

  • Internal Medicine Physician
  • Medford, MA
National Provider Identifier
1962686816
Registry record updated May 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MT AUBURN PROFESSIONAL SERVICE
Practice address
101 Main St
Ste 110
Medford, MA 02155-4540
Phone
(781) 396-4514
Fax
(781) 322-1394
NPI assigned
Dec 27, 2007
Last updated
May 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2024

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

Authorized official

Name
Mr. Brian Smith
Title
Cfo
Phone
(405) 245-6238

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

101 Main St
Ste 110
Medford, MA 02155-4540

Mailing address

One Arsenal Marketplace
Watertown, MA 02472
Phone (617) 673-1851

Other identifiers 1

IdentifierTypeStateIssuer
M19292OtherMABLUE CROSS

National Provider Directory

National Provider Directory
Tax ID family
Mt Auburn Medical Assoc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

101 Main St
Ste 110
Medford, MA 02155
Phone (781) 391-6318

NPI Registry JSON

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

{
    "created_epoch": "1198713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714867200000",
    "number": "1962686816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ONE ARSENAL MARKETPLACE",
            "city": "WATERTOWN",
            "state": "MA",
            "postal_code": "02472",
            "telephone_number": "617-673-1851",
            "fax_number": "617-499-5579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MAIN ST",
            "address_2": "STE 110",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021554540",
            "telephone_number": "781-396-4514",
            "fax_number": "781-322-1394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT AUBURN PROFESSIONAL SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-27",
        "last_updated": "2024-05-05",
        "certification_date": "2024-05-05",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "405-245-6238",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "M19292",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2024; 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.