Provider Demographics
NPI:1558866129
Name:HESED MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:HESED MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-512-2515
Mailing Address - Street 1:12 LANCASTER ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-2807
Mailing Address - Country:US
Mailing Address - Phone:617-512-2515
Mailing Address - Fax:
Practice Address - Street 1:25 MARSTON ST APT 405
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2359
Practice Address - Country:US
Practice Address - Phone:978-682-3939
Practice Address - Fax:617-876-1872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-27
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA57709207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110045454AMedicaid
MA400382OtherTUFTS
MAAA228198OtherHARVARD PILGRIM HEALTH CARE
MAJ07206OtherBCBS