Provider Demographics
NPI:1679797211
Name:TRUSTEES OF TUFTS UNIVERSITY
Entity type:Organization
Organization Name:TRUSTEES OF TUFTS UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:781-899-6020
Mailing Address - Street 1:2007 BAY ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-1086
Mailing Address - Country:US
Mailing Address - Phone:508-823-7323
Mailing Address - Fax:508-823-7932
Practice Address - Street 1:2007 BAY ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-1086
Practice Address - Country:US
Practice Address - Phone:508-823-7323
Practice Address - Fax:508-823-7932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20040261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0272183OtherMASSHEALTH PROVIDER NUMBE