Provider Demographics
NPI:1134127061
Name:UNITED PROSTHETICS, INC
Entity Type:Organization
Organization Name:UNITED PROSTHETICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-436-6110
Mailing Address - Street 1:295 COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02121-3409
Mailing Address - Country:US
Mailing Address - Phone:617-436-6110
Mailing Address - Fax:617-436-2424
Practice Address - Street 1:295 COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121-3409
Practice Address - Country:US
Practice Address - Phone:617-436-6110
Practice Address - Fax:617-436-2424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Not Answered222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8200039OtherEVERCARE
983356OtherNETWORK HEALTH
000000005606OtherBOSTON MEDICAL CENTER HEL
0143800OtherWASHINGTON WIC
700010OtherHCHP
000155OtherTUFTS
0007137OtherNEIGHBORHOOD HEALTH PLAN
MA1505505Medicaid
359854OtherBCBS
359854OtherBCBS