Provider Demographics
NPI:1982661062
Name:MASSACHUSETTS CARDIOLOGY ASSOC LLC
Entity Type:Organization
Organization Name:MASSACHUSETTS CARDIOLOGY ASSOC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-624-9687
Mailing Address - Street 1:159 UNION ST
Mailing Address - Street 2:STE 102
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-1274
Mailing Address - Country:US
Mailing Address - Phone:508-624-9687
Mailing Address - Fax:508-624-9689
Practice Address - Street 1:159 UNION ST
Practice Address - Street 2:STE 102
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-9689
Practice Address - Country:US
Practice Address - Phone:508-624-9687
Practice Address - Fax:508-624-9689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73472207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
691560OtherTUFTS
073472OtherTUFTS
59596OtherFALLON
3563OtherHPHC
J10493OtherBCBS
MA3069958Medicaid
M21347Medicare ID - Type Unspecified
59596OtherFALLON
MA3069958Medicaid