Provider Demographics
NPI:1811635899
Name:MASS GENERAL BRIGHAM MEDICAL GROUP NORTHERN MASSACHUSETTS INC
Entity type:Organization
Organization Name:MASS GENERAL BRIGHAM MEDICAL GROUP NORTHERN MASSACHUSETTS INC
Other - Org Name:
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 1:81 HIGHLAND AVE
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2714
Mailing Address - Country:US
Mailing Address - Phone:978-354-4173
Mailing Address - Fax:978-354-3963
Practice Address - Street 1:4 CENTENNIAL DR STE 202
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7930
Practice Address - Country:US
Practice Address - Phone:978-771-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MASS GENERAL BRIGHAM MEDICAL GROUP NORTHERN MASSACHUSETTS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-20
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies