Provider Demographics
NPI:1912324641
Name:CARDIOVASCULAR ASSOCIATES OF SANDWICH
Entity Type:Organization
Organization Name:CARDIOVASCULAR ASSOCIATES OF SANDWICH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:BEATRICE
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:774-413-5457
Mailing Address - Street 1:PO BOX 1757
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563-1757
Mailing Address - Country:US
Mailing Address - Phone:774-413-5457
Mailing Address - Fax:774-413-5985
Practice Address - Street 1:68A ROUTE 6A
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563-1757
Practice Address - Country:US
Practice Address - Phone:774-413-5457
Practice Address - Fax:774-413-5985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160179261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty