1689917726 NPI number — CAMBRIDGE UROLOGICAL ASSOCIATES, INC

Table of content: (NPI 1689917726)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689917726 NPI number — CAMBRIDGE UROLOGICAL ASSOCIATES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAMBRIDGE UROLOGICAL 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:
Provider Other Organization Name Type Code:
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:
1689917726
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 MOUNT AUBURN ST
Provider Second Line Business Mailing Address:
STE 519
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02138-5600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-547-4400
Provider Business Mailing Address Fax Number:
617-576-1076

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
790 BOSTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BILLERICA
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01821-5938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-547-4400
Provider Business Practice Location Address Fax Number:
617-576-1076
Provider Enumeration Date:
03/27/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CROCKER
Authorized Official First Name:
RODERICK
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
617-547-4400

Provider Taxonomy Codes

  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110067128A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com