Provider Demographics
NPI:1750421673
Name:WOBURN NEPHROLOGY ASSOCIATES PC
Entity type:Organization
Organization Name:WOBURN NEPHROLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER IN ORGANIZATION
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-933-0710
Mailing Address - Street 1:23 WARREN AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801
Mailing Address - Country:US
Mailing Address - Phone:781-933-0710
Mailing Address - Fax:781-937-3947
Practice Address - Street 1:23 WARREN AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801
Practice Address - Country:US
Practice Address - Phone:781-933-0710
Practice Address - Fax:781-937-3947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA695131OtherTUFTS
MAM18118OtherBLUE CROSS BLUE SHIELD
M21220Medicare PIN