Provider Demographics
NPI:1790874352
Name:BROCKTON CARDIOLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:BROCKTON CARDIOLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:L
Authorized Official - Last Name:KRIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-583-6262
Mailing Address - Street 1:210 QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-2862
Mailing Address - Country:US
Mailing Address - Phone:508-583-6262
Mailing Address - Fax:508-583-1783
Practice Address - Street 1:210 QUINCY AVE
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-2862
Practice Address - Country:US
Practice Address - Phone:508-583-6262
Practice Address - Fax:508-583-1783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9769153Medicaid
MAM15659OtherBCBS GROUP #
MA122415OtherAETNA GROUP #
MA25227OtherUNITED GROUP #
MA600871OtherTUFTS GROUP #
MA25227OtherUNITED GROUP #