Provider Demographics
NPI:1740365329
Name:TOWN OF WRENTHAM
Entity type:Organization
Organization Name:TOWN OF WRENTHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN B.O.H.
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVINDRA
Authorized Official - Middle Name:MOHAN
Authorized Official - Last Name:NADKARNI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:508-384-5480
Mailing Address - Street 1:79 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:WRENTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02093-1526
Mailing Address - Country:US
Mailing Address - Phone:508-384-5485
Mailing Address - Fax:508-384-5461
Practice Address - Street 1:79 SOUTH ST
Practice Address - Street 2:
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093-1526
Practice Address - Country:US
Practice Address - Phone:508-384-5485
Practice Address - Fax:508-384-5461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY11073Medicare ID - Type UnspecifiedROSTER B BILLING