Provider Demographics
NPI:1497778450
Name:D & G ASSOCIATES WALTHAM, INC.
Entity Type:Organization
Organization Name:D & G ASSOCIATES WALTHAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLASKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-767-3486
Mailing Address - Street 1:22 WINTER ST
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:MA
Mailing Address - Zip Code:02343-1033
Mailing Address - Country:US
Mailing Address - Phone:781-767-3486
Mailing Address - Fax:
Practice Address - Street 1:1440 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1623
Practice Address - Country:US
Practice Address - Phone:781-891-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110296207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty