Basic Information
| Provider Information | |||||||||
| NPI: | 1811540727 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOUNT AUBURN HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 MOUNT AUBURN ST | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021385502 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 330 MOUNT AUBURN ST | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021385502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174923500 | ||||||||
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| ProviderEnumerationDate: | 07/19/2019 | ||||||||
| LastUpdateDate: | 07/19/2019 | ||||||||
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| AuthorizedOfficialLastName: | KALUTKIEWICZ | ||||||||
| AuthorizedOfficialFirstName: | KATELYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 6173722767 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.