Provider Demographics
NPI:1639202252
Name:ATRIUS HEALTH, INC. DBA HARVARD VANGUARD MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:ATRIUS HEALTH, INC. DBA HARVARD VANGUARD MEDICAL ASSOCIATES
Other - Org Name:HARVARD VANGUARD MEDICAL ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF PHARMACY REVENUE AND SU
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARDARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:617-972-5321
Mailing Address - Street 1:275 GROVE ST
Mailing Address - Street 2:SUITE 3-300
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-2272
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 GROSSMAN DR
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-4997
Practice Address - Country:US
Practice Address - Phone:781-849-1000
Practice Address - Fax:781-849-2327
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATRIUS HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA00514493336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0402494Medicaid
MA2229575OtherNCPDP
MABH7452535OtherDEA #