Provider Demographics
NPI:1285645291
Name:SUBURBAN CARDIOLOGY AND INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:SUBURBAN CARDIOLOGY AND INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACC
Authorized Official - Prefix:DR
Authorized Official - First Name:AUROBINDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAKRABORTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-647-1600
Mailing Address - Street 1:190 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760
Mailing Address - Country:US
Mailing Address - Phone:508-647-1600
Mailing Address - Fax:508-647-1695
Practice Address - Street 1:190 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760
Practice Address - Country:US
Practice Address - Phone:508-647-1600
Practice Address - Fax:508-647-1695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9773894Medicaid
MAM16001Medicare PIN