Provider Demographics
NPI:1396942926
Name:HARBOR MEDICAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:HARBOR MEDICAL ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-952-1249
Mailing Address - Street 1:541 MAIN ST
Mailing Address - Street 2:SUITE 420
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1868
Mailing Address - Country:US
Mailing Address - Phone:781-952-1367
Mailing Address - Fax:781-952-1379
Practice Address - Street 1:541 MAIN ST
Practice Address - Street 2:SUITE 420
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1868
Practice Address - Country:US
Practice Address - Phone:781-952-1367
Practice Address - Fax:781-952-1379
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARBOR MEDICAL ASSOCIATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-28
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA59350291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP00154072OtherRAILROAD MEDICARE
MA805999OtherTUFTS HEALTH PLAN
MA0810908Medicaid
MA0810908Medicaid