Provider Demographics
NPI:1891704730
Name:PILGRIM UROLOGICAL ASSOCIATES INC.
Entity Type:Organization
Organization Name:PILGRIM UROLOGICAL ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROMANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-746-6557
Mailing Address - Street 1:110 LONG POND RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2642
Mailing Address - Country:US
Mailing Address - Phone:508-746-6557
Mailing Address - Fax:508-746-6591
Practice Address - Street 1:110 LONG POND RD
Practice Address - Street 2:SUITE 105
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2642
Practice Address - Country:US
Practice Address - Phone:508-746-6557
Practice Address - Fax:508-746-6591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9757996Medicaid
MAM14843Medicare ID - Type Unspecified