Provider Demographics
NPI:1710030457
Name:ADULT AND PEDIATRIC UROLOGY CENTER
Entity Type:Organization
Organization Name:ADULT AND PEDIATRIC UROLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REKHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-344-3506
Mailing Address - Street 1:966 PARK ST # B
Mailing Address - Street 2:SUITE B3
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3650
Mailing Address - Country:US
Mailing Address - Phone:781-344-3506
Mailing Address - Fax:781-341-4065
Practice Address - Street 1:966 PARK ST # B
Practice Address - Street 2:SUITE B3
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-3650
Practice Address - Country:US
Practice Address - Phone:781-344-3506
Practice Address - Fax:781-341-4065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9787704Medicaid
MA9787704Medicaid