Provider Demographics
NPI:1376624783
Name:HEALTHWISE DIAGNOSTIC CENTER
Entity Type:Organization
Organization Name:HEALTHWISE DIAGNOSTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-762-2758
Mailing Address - Street 1:175 WALPOLE ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3230
Mailing Address - Country:US
Mailing Address - Phone:781-762-2758
Mailing Address - Fax:781-769-2209
Practice Address - Street 1:175 WALPOLE ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3230
Practice Address - Country:US
Practice Address - Phone:781-762-2758
Practice Address - Fax:781-769-2209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA327120Medicare ID - Type Unspecified