Basic Information
Provider Information
NPI: 1821236019
EntityType: 2
ReplacementNPI:  
OrganizationName: BEVERLY HOSPITAL
LastName:  
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Credential:  
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Mailing Information
Address1: 143 FAYETTE ST
Address2:  
City: WATERTOWN
State: MA
PostalCode: 024723705
CountryCode: US
TelephoneNumber: 6073313177
FaxNumber:  
Practice Location
Address1: 85 HERRICK STREET
Address2: BEVERLY HOSPITAL
City: BEVERLY
State: MA
PostalCode: 019151777
CountryCode: US
TelephoneNumber: 9789223000
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/27/2009
LastUpdateDate: 01/27/2009
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: HATCH
AuthorizedOfficialFirstName: STEPHAN
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AuthorizedOfficialTitleorPosition: CHIEF OF ANESTHESIOLOGY
AuthorizedOfficialTelephone: 9789223000
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: M.D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282N00000XRN272611MAY HospitalsGeneral Acute Care Hospital 

No ID Information.


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