Provider Demographics
NPI:1487851580
Name:HOPEDALE CARDIOLOGY, PC
Entity Type:Organization
Organization Name:HOPEDALE CARDIOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-473-1015
Mailing Address - Street 1:236 MILFORD ST
Mailing Address - Street 2:
Mailing Address - City:UPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01568-1309
Mailing Address - Country:US
Mailing Address - Phone:508-473-1015
Mailing Address - Fax:508-634-0261
Practice Address - Street 1:236 MILFORD ST.
Practice Address - Street 2:
Practice Address - City:UPTON
Practice Address - State:MA
Practice Address - Zip Code:01568
Practice Address - Country:US
Practice Address - Phone:508-473-1015
Practice Address - Fax:508-634-0261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207RC0000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0001687Medicare PIN