Provider Demographics
NPI:1396083051
Name:BOSTON WEST CARDIOLOGY
Entity type:Organization
Organization Name:BOSTON WEST CARDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RIFAT
Authorized Official - Middle Name:
Authorized Official - Last Name:DWEIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-894-1199
Mailing Address - Street 1:20 HOPE AVE STE G07
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-2717
Mailing Address - Country:US
Mailing Address - Phone:781-894-1199
Mailing Address - Fax:781-657-6178
Practice Address - Street 1:20 HOPE AVE STE G07
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-2717
Practice Address - Country:US
Practice Address - Phone:781-894-1199
Practice Address - Fax:781-657-6178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA58014207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3024792Medicaid
MA9710400Medicaid
MA058014OtherTUFTS
MAM17863OtherBLUE CROSS BLUE SHIELD
MA058014OtherTUFTS