Provider Demographics
NPI: | 1225175979 |
---|---|
Name: | ATRIUS HEALTH, INC |
Entity Type: | Organization |
Organization Name: | ATRIUS HEALTH, INC |
Other - Org Name: | HARVARD VANGUARD MEDICAL ASSOCIATES |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | INTERIM CHIEF EXECUTIVE OFFICER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | DANIEL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BURNES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 617-559-8393 |
Mailing Address - Street 1: | 275 GROVE ST |
Mailing Address - Street 2: | SUITE 3-300 |
Mailing Address - City: | AUBURNDALE |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 02466-2272 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 617-559-8374 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 133 BROOKLINE AVE |
Practice Address - Street 2: | |
Practice Address - City: | BOSTON |
Practice Address - State: | MA |
Practice Address - Zip Code: | 02215-3904 |
Practice Address - Country: | US |
Practice Address - Phone: | 617-559-8374 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-01-31 |
Last Update Date: | 2015-06-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
No | 364S00000X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Group - Multi-Specialty | |
No | 367A00000X | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MA | 610300 | Other | TUFTS |