Provider Demographics
NPI:1598756132
Name:HEART CENTER OF METROWEST INC
Entity Type:Organization
Organization Name:HEART CENTER OF METROWEST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SUSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-875-4811
Mailing Address - Street 1:99 LINCOLN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6327
Mailing Address - Country:US
Mailing Address - Phone:508-875-4811
Mailing Address - Fax:508-875-5942
Practice Address - Street 1:99 LINCOLN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6327
Practice Address - Country:US
Practice Address - Phone:508-875-4811
Practice Address - Fax:508-875-5942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
54844OtherFALLON
0026245OtherNHP
2793399OtherAETNA/USHC
CJ7882OtherPALMETTO GBA (RR MCARE)
MAM17996OtherBCBSMA
MA9720197Medicaid
699390OtherTUFTS
2793399OtherAETNA/USHC
699390OtherTUFTS
CJ7882OtherPALMETTO GBA (RR MCARE)
=========OtherUHC