Provider Demographics
NPI:1467423038
Name:BIOCARDIA DIAGNOSTICS INC
Entity Type:Organization
Organization Name:BIOCARDIA DIAGNOSTICS INC
Other - Org Name:BIOCARE DIAGNOSTICS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR. OPERATIONS/DEVEL
Authorized Official - Prefix:
Authorized Official - First Name:AURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-232-0317
Mailing Address - Street 1:1180 BEACON ST
Mailing Address - Street 2:SUITE 7C
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-3885
Mailing Address - Country:US
Mailing Address - Phone:617-232-0317
Mailing Address - Fax:617-739-0621
Practice Address - Street 1:1180 BEACON ST
Practice Address - Street 2:SUITE 7C
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3885
Practice Address - Country:US
Practice Address - Phone:617-232-0317
Practice Address - Fax:617-739-0621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAM245261QR0200X, 261QR0206X, 293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
No293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1540513Medicaid
MA026269Medicare PIN