Provider Demographics
NPI:1063630366
Name:CAMBRIDGE HOSP PROF SER
Entity Type:Organization
Organization Name:CAMBRIDGE HOSP PROF SER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO BILLING
Authorized Official - Prefix:MISS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:D'AGOSTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-933-3734
Mailing Address - Street 1:110 WINN ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-2897
Mailing Address - Country:US
Mailing Address - Phone:781-933-3734
Mailing Address - Fax:781-932-3278
Practice Address - Street 1:1493 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1047
Practice Address - Country:US
Practice Address - Phone:781-933-3734
Practice Address - Fax:781-932-3278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA610101OtherTUFTS ASSOCIATED HEALTH
MA9773622Medicaid
MAHH57OtherHARVARD PILGRIM HEALTH
MAM15989OtherBLUE CROSS BLUE SHIELD
MAM15989OtherBLUE CROSS BLUE SHIELD