Provider Demographics
NPI:1104815489
Name:ORTHOPAEDIC SPECIALISTS OF MASSACHUSETTS PC
Entity type:Organization
Organization Name:ORTHOPAEDIC SPECIALISTS OF MASSACHUSETTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:PATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-769-6720
Mailing Address - Street 1:825 WASHINGTON ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3441
Mailing Address - Country:US
Mailing Address - Phone:781-769-6720
Mailing Address - Fax:781-769-0691
Practice Address - Street 1:825 WASHINGTON ST
Practice Address - Street 2:SUITE 260
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3441
Practice Address - Country:US
Practice Address - Phone:781-769-6720
Practice Address - Fax:781-769-0691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA680357OtherTUFTS
MA9786724Medicaid
MAM17397OtherBCBS
MA9786724Medicaid
MAA28901Medicare ID - Type Unspecified