Provider Demographics
NPI:1801385380
Name:MOUNTAIN HEALTH DIAGNOSTICS
Entity Type:Organization
Organization Name:MOUNTAIN HEALTH DIAGNOSTICS
Other - Org Name:MOUNTAIN HEALTH DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:S
Authorized Official - Last Name:WEISER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-206-2090
Mailing Address - Street 1:280 WASHINGTON ST STE 205
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3511
Mailing Address - Country:US
Mailing Address - Phone:617-744-9390
Mailing Address - Fax:855-829-6228
Practice Address - Street 1:280 WASHINGTON ST STE 205
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3511
Practice Address - Country:US
Practice Address - Phone:617-744-9390
Practice Address - Fax:855-829-6228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-09
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000041HUMedicaid