Provider Demographics
NPI:1033108576
Name:METROWEST VASCULAR PC
Entity Type:Organization
Organization Name:METROWEST VASCULAR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-655-8900
Mailing Address - Street 1:460 TOTTEN POND RD
Mailing Address - Street 2:MZI
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1991
Mailing Address - Country:US
Mailing Address - Phone:781-890-9933
Mailing Address - Fax:781-890-9950
Practice Address - Street 1:67 UNION ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-7700
Practice Address - Country:US
Practice Address - Phone:508-655-8900
Practice Address - Fax:508-650-7926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM17754OtherBCBS
MA9706500Medicaid
MA690448OtherTUFTS
MAM20949Medicare ID - Type Unspecified