Provider Demographics
NPI:1710497383
Name:METROWEST UROLOGIC ASSOCIATES PC
Entity Type:Organization
Organization Name:METROWEST UROLOGIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:KACKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-481-4360
Mailing Address - Street 1:67 UNION ST STE 308
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-7700
Mailing Address - Country:US
Mailing Address - Phone:508-655-4422
Mailing Address - Fax:508-655-9191
Practice Address - Street 1:67 UNION ST STE 308
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-7700
Practice Address - Country:US
Practice Address - Phone:508-655-4422
Practice Address - Fax:508-655-9191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty