Provider Demographics
NPI:1134294697
Name:WALTHAM WESTON INTERNAL MEDICINE ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:WALTHAM WESTON INTERNAL MEDICINE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCINTYRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-547-6030
Mailing Address - Street 1:9 HOPE AVE
Mailing Address - Street 2:SUITE 152
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-2741
Mailing Address - Country:US
Mailing Address - Phone:781-547-6030
Mailing Address - Fax:781-547-6036
Practice Address - Street 1:9 HOPE AVE
Practice Address - Street 2:SUITE 152
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-2741
Practice Address - Country:US
Practice Address - Phone:781-547-6030
Practice Address - Fax:781-547-6036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9746081Medicaid
M21763Medicare ID - Type Unspecified