Provider Demographics
NPI:1538185475
Name:THE MCLEAN HOSPITAL CORPORATION
Entity type:Organization
Organization Name:THE MCLEAN HOSPITAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-855-2367
Mailing Address - Street 1:PO BOX 415578
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5578
Mailing Address - Country:US
Mailing Address - Phone:617-724-3371
Mailing Address - Fax:617-724-9687
Practice Address - Street 1:115 MILL ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-1041
Practice Address - Country:US
Practice Address - Phone:617-855-3316
Practice Address - Fax:617-855-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA11002747AMedicaid
MA2222400710OtherBC/BS
MA2222400701OtherBC/BS
MA110027417CMedicaid
MA110027417CMedicaid