Provider Demographics
NPI:1689875288
Name:CARDIO - THORACIC & VASCULAR SURGERY INC
Entity Type:Organization
Organization Name:CARDIO - THORACIC & VASCULAR SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-737-4715
Mailing Address - Street 1:2 MEDICAL CENTER DR SUITE 104
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107
Mailing Address - Country:US
Mailing Address - Phone:413-737-4715
Mailing Address - Fax:413-737-4875
Practice Address - Street 1:2 MEDICAL CENTER DR SUITE 104
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107
Practice Address - Country:US
Practice Address - Phone:413-737-4715
Practice Address - Fax:413-737-4875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36381174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2017857Medicaid
MA9731571Medicaid
MAB98628Medicare UPIN
MAM08653Medicare ID - Type Unspecified
MA2017857Medicaid