Provider Demographics
NPI:1073725990
Name:FRAMINGHAM CARDIOLOGY DIAGNOSTICS
Entity Type:Organization
Organization Name:FRAMINGHAM CARDIOLOGY DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MELENCIO
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:508-620-2800
Mailing Address - Street 1:680 WORCESTER ROAD
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-5259
Mailing Address - Country:US
Mailing Address - Phone:508-620-2800
Mailing Address - Fax:508-620-2808
Practice Address - Street 1:115 LINCOLN STREET
Practice Address - Street 2:METROWEST MEDICAL CENTER
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702
Practice Address - Country:US
Practice Address - Phone:508-879-6026
Practice Address - Fax:508-879-8958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MANOT APPLICABLE207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9766146Medicaid
MAM15352Medicare ID - Type UnspecifiedPROVIDER NUMBER