Provider Demographics
NPI:1801499348
Name:WOBURN NEPHROLOGY ASSOCIATES PC
Entity type:Organization
Organization Name:WOBURN NEPHROLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-933-0710
Mailing Address - Street 1:23 WARREN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-4986
Mailing Address - Country:US
Mailing Address - Phone:781-933-0710
Mailing Address - Fax:
Practice Address - Street 1:23 WARREN AVE STE 150
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-4986
Practice Address - Country:US
Practice Address - Phone:781-933-0710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOBURN NEPHROLOGY ASSOCIATES PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty