Provider Demographics
NPI:1437295714
Name:NEWTON WELLESLEY SURGEONS INC
Entity Type:Organization
Organization Name:NEWTON WELLESLEY SURGEONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:K
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-244-5355
Mailing Address - Street 1:2000 WASHINGTON STREET
Mailing Address - Street 2:SUITE 365
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1627
Mailing Address - Country:US
Mailing Address - Phone:617-244-5355
Mailing Address - Fax:617-244-8662
Practice Address - Street 1:2000 WASHINGTON ST
Practice Address - Street 2:SUITE 365
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1650
Practice Address - Country:US
Practice Address - Phone:617-244-5355
Practice Address - Fax:617-244-8662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9732675Medicaid
MA9732675Medicaid