Provider Demographics
NPI:1851584379
Name:WALTHAM DIABETES CENTER, LLC
Entity Type:Organization
Organization Name:WALTHAM DIABETES CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHRODER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-647-7220
Mailing Address - Street 1:42 WESTON ST
Mailing Address - Street 2:WALTHAM DIABETES CENTER SUITE 8
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-7756
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:42 WESTON ST
Practice Address - Street 2:WALTHAM DIABETES CENTER SUITE 8
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-7756
Practice Address - Country:US
Practice Address - Phone:781-647-7220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty