Provider Demographics
NPI:1184823429
Name:HARBOR MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:HARBOR MEDICAL ASSOCIATES
Other - Org Name:PHYSICIANS DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-952-1200
Mailing Address - Street 1:541 MAIN ST
Mailing Address - Street 2:SUITE 314
Mailing Address - City:S WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1868
Mailing Address - Country:US
Mailing Address - Phone:781-952-1460
Mailing Address - Fax:
Practice Address - Street 1:541 MAIN ST
Practice Address - Street 2:SUITE 314
Practice Address - City:S WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1868
Practice Address - Country:US
Practice Address - Phone:781-952-1460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARBOR MEDICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-17
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA637718OtherTUFTS HEALTH PLAN