1689909723 NPI number — HARBOR MEDICAL ASSOCIATES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689909723 NPI number — HARBOR MEDICAL ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARBOR MEDICAL ASSOCIATES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PHYSICIAN DIAGNOSTICS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689909723
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 COLUMBIAN ST
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
S. WEYMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02190-1868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-624-4860
Provider Business Mailing Address Fax Number:
781-624-2670

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 COLUMBIAN ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
S. WEYMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02190-1868
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-624-4860
Provider Business Practice Location Address Fax Number:
781-624-2670
Provider Enumeration Date:
10/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GRAPE
Authorized Official First Name:
PETER
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
781-952-1249

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  46505 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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