Provider Demographics
NPI:1225010846
Name:TWINBROOK SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:TWINBROOK SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:781-893-6520
Mailing Address - Street 1:20 HOPE AVE
Mailing Address - Street 2:STE 207
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-2721
Mailing Address - Country:US
Mailing Address - Phone:781-893-6520
Mailing Address - Fax:781-893-6522
Practice Address - Street 1:20 HOPE AVE
Practice Address - Street 2:STE 207
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-2721
Practice Address - Country:US
Practice Address - Phone:781-893-6520
Practice Address - Fax:781-893-6522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9701346Medicaid
MACJ0290OtherRAILROAD MEDICARE
MACJ0290OtherRAILROAD MEDICARE