Provider Demographics
NPI:1689909723
Name:HARBOR MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:HARBOR MEDICAL ASSOCIATES, INC.
Other - Org Name:PHYSICIAN DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-952-1249
Mailing Address - Street 1:101 COLUMBIAN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:S. WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1868
Mailing Address - Country:US
Mailing Address - Phone:781-624-4860
Mailing Address - Fax:781-624-2670
Practice Address - Street 1:101 COLUMBIAN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:S. WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1868
Practice Address - Country:US
Practice Address - Phone:781-624-4860
Practice Address - Fax:781-624-2670
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARBOR MEDICAL ASSOCIATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA465052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA32711401Medicare PIN