Provider Demographics
NPI:1164772299
Name:DRX UC WATERTOWN PC
Entity Type:Organization
Organization Name:DRX UC WATERTOWN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCHARUKH
Authorized Official - Middle Name:
Authorized Official - Last Name:JALISI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-795-7082
Mailing Address - Street 1:376 ARSENAL ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2892
Mailing Address - Country:US
Mailing Address - Phone:617-923-2273
Mailing Address - Fax:617-744-0654
Practice Address - Street 1:376 ARSENAL ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2892
Practice Address - Country:US
Practice Address - Phone:617-923-2273
Practice Address - Fax:617-744-0654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-17
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care