Provider Demographics
NPI:1710008982
Name:ASSOCIATED INTERNISTS OF RANDOLPH, INC.
Entity Type:Organization
Organization Name:ASSOCIATED INTERNISTS OF RANDOLPH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-801-8330
Mailing Address - Street 1:108 BREAKWATER SHORES DR
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-4800
Mailing Address - Country:US
Mailing Address - Phone:508-790-8219
Mailing Address - Fax:508-534-9950
Practice Address - Street 1:NEW ENGLAND SINAI HOSPITAL
Practice Address - Street 2:250 YORK STREET
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072
Practice Address - Country:US
Practice Address - Phone:781-344-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA32453207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty