Provider Demographics
NPI:1942373691
Name:UROLOGY CENTRAL PC
Entity Type:Organization
Organization Name:UROLOGY CENTRAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:EBB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-466-2280
Mailing Address - Street 1:50 MEMORIAL DRIVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453
Mailing Address - Country:US
Mailing Address - Phone:978-466-2280
Mailing Address - Fax:978-466-2282
Practice Address - Street 1:50 MEMORIAL DRIVE
Practice Address - Street 2:SUITE 108
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453
Practice Address - Country:US
Practice Address - Phone:978-466-2280
Practice Address - Fax:978-466-2282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2018-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212873208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0002695OtherGRP MEDICARE
MA2110717Medicaid
637642OtherGRP TUFTS
M19406OtherBLUE CROSS GRP
MA2110717Medicaid
M19406OtherBLUE CROSS GRP