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6 Bigelow St Cambridge MA 02139-2384 | |
| (617) 335-7215 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 6 Bigelow St, Cambridge, Massachusetts |
| Authorized Official Name and Position | Daniel Tucker Thompson (MANAGING DIRECTOR) |
| Authorized Official Contact | 6178039722 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
6 Bigelow St Cambridge MA 02139-2384 Ph: (617) 335-7215 | 6 Bigelow St Cambridge MA 02139-2384 Ph: (617) 335-7215 |
| NPI Number | 1245776368 |
|---|---|
| Provider Enumeration Date | 01/12/2017 |
| Last Update Date | 02/23/2018 |
| Medicare PECOS PAC ID | 4688933377 |
|---|---|
| Medicare Enrollment ID | O20240828001064 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245776368 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 154311 (Massachusetts) | Primary |
| Provider Name | Holly Randall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326124934 PECOS PAC ID: 4082711783 Enrollment ID: I20240315000972 |
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