Provider Demographics
NPI:1720031248
Name:NASHOBA VALLEY UROLOGY, INC
Entity Type:Organization
Organization Name:NASHOBA VALLEY UROLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RATHORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-772-5419
Mailing Address - Street 1:190 GROTON RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:AYER
Mailing Address - State:MA
Mailing Address - Zip Code:01432-1124
Mailing Address - Country:US
Mailing Address - Phone:978-772-5419
Mailing Address - Fax:978-772-7006
Practice Address - Street 1:190 GROTON RD
Practice Address - Street 2:SUITE 230
Practice Address - City:AYER
Practice Address - State:MA
Practice Address - Zip Code:01432-1124
Practice Address - Country:US
Practice Address - Phone:978-772-5419
Practice Address - Fax:978-772-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA037036174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9715959Medicaid
MA0028516OtherNEIGHBORHOOD
MACM9560OtherRAILROAD MEDICARE
MAM12384OtherBLUE CROSS BLUE SHIELD
MA701713OtherTUFTS
MA701713OtherTUFTS
MAM12384OtherBLUE CROSS BLUE SHIELD
MACM9560OtherRAILROAD MEDICARE