Provider Demographics
NPI:1164840484
Name:FRESENIUS MEDICAL CARE CNV MARLBOROUGH, LLC
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE CNV MARLBOROUGH, LLC
Other - Org Name:FRESENIUS MEDICAL CARE OF MARLBOROUGH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:360 CEDAR HILL ST STE 3
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-4175
Mailing Address - Country:US
Mailing Address - Phone:508-460-9250
Mailing Address - Fax:508-460-9251
Practice Address - Street 1:360 CEDAR HILL ST STE 3
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-4175
Practice Address - Country:US
Practice Address - Phone:508-460-9250
Practice Address - Fax:508-460-9251
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-03
Last Update Date:2023-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
222570Medicare Oscar/Certification