Provider Demographics
NPI:1578552964
Name:CENTRAL MA CARDIOVASCULAR PHYSICIANS INC
Entity Type:Organization
Organization Name:CENTRAL MA CARDIOVASCULAR PHYSICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:W
Authorized Official - Last Name:CEREL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-772-5755
Mailing Address - Street 1:198 GROTON ROAD
Mailing Address - Street 2:STE 4
Mailing Address - City:AYER
Mailing Address - State:MA
Mailing Address - Zip Code:01432
Mailing Address - Country:US
Mailing Address - Phone:978-772-5755
Mailing Address - Fax:978-772-1611
Practice Address - Street 1:198 GROTON ROAD
Practice Address - Street 2:STE 4
Practice Address - City:AYER
Practice Address - State:MA
Practice Address - Zip Code:01432
Practice Address - Country:US
Practice Address - Phone:978-772-5755
Practice Address - Fax:978-772-1611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72365207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3186991OtherAETNA
688811OtherTUFTS HEALTH PLAN
MA9729534Medicaid
MA9729534Medicaid