Provider Demographics
NPI:1538191218
Name:MASS GENERAL BRIGHAM MEDICAL GROUP SUBURBAN MASSACHUSETTS INC
Entity type:Organization
Organization Name:MASS GENERAL BRIGHAM MEDICAL GROUP SUBURBAN MASSACHUSETTS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & COO
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-282-3914
Mailing Address - Street 1:399 REVOLUTION DR
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-1484
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2014 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1607
Practice Address - Country:US
Practice Address - Phone:617-243-6262
Practice Address - Fax:617-243-6954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA610605OtherTUFTS
MAM18007OtherBLUE CROSS
MAM18311OtherBLUE CROSS PSYCHIATRY
MA110067798AMedicaid
VA247616OtherANTHEM BCBS
MA9711597Medicaid
MA110067798AMedicaid
MA222560501OtherNETWORK HEALTH
MA222560501OtherGUARDIAN LIFE
MA9711597Medicaid
VA247616OtherANTHEM BCBS
MA222560501OtherAETNA
RI222560501OtherUNITED HC
MA610605OtherTUFTS
222560501OtherHEALTHY START PROGRAM
MA222560501OtherGIC UNICARE
222560501OtherAARP
MA222560501OtherUNITED HC
MA222560501OtherHPHC
MAM18311OtherBLUE CROSS PSYCHIATRY
MAM21100Medicare ID - Type UnspecifiedMEDICARE