Provider Demographics
NPI:1437291879
Name:NEPONSET VALLEY ORTHOPEDICS, PC
Entity Type:Organization
Organization Name:NEPONSET VALLEY ORTHOPEDICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:BENTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-762-4330
Mailing Address - Street 1:24 GUILD ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3425
Mailing Address - Country:US
Mailing Address - Phone:781-762-4330
Mailing Address - Fax:781-762-0140
Practice Address - Street 1:24 GUILD ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3425
Practice Address - Country:US
Practice Address - Phone:781-762-4330
Practice Address - Fax:781-762-0140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0494460001Medicare NSC