Provider Demographics
NPI:1891907366
Name:HARVARD VANGUARD MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:HARVARD VANGUARD MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:H. EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-559-8260
Mailing Address - Street 1:275 GROVE STREET
Mailing Address - Street 2:SUITE 3-300
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02466
Mailing Address - Country:US
Mailing Address - Phone:517-559-8374
Mailing Address - Fax:617-421-3487
Practice Address - Street 1:1153 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130
Practice Address - Country:US
Practice Address - Phone:617-522-7041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0033418OtherNEIGHBORHOOD HEALTH PLAN
MAM18801OtherBLUE CROSS BLUE SHIELD
MA5022120022Medicare NSC
MAPY0140Medicare PIN
MA0033418OtherNEIGHBORHOOD HEALTH PLAN
MAPT0137Medicare PIN