Provider Demographics
NPI:1275628174
Name:RIVERSIDE NEPHROLOGY PC
Entity Type:Organization
Organization Name:RIVERSIDE NEPHROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:S
Authorized Official - Last Name:HADDAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-686-4343
Mailing Address - Street 1:35 UNITED DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WEST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02379-1027
Mailing Address - Country:US
Mailing Address - Phone:508-238-8646
Mailing Address - Fax:
Practice Address - Street 1:575 TURNPIKE ST STE 17
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5937
Practice Address - Country:US
Practice Address - Phone:978-686-4343
Practice Address - Fax:978-682-5191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA805418OtherTUFTS
MAM16918OtherBLUE CROSS
MA9783512Medicaid
MA9783512Medicaid