Provider Demographics
NPI:1104951474
Name:NEWTON WELLESLEY CARDIOLOGISTS, P.C.
Entity type:Organization
Organization Name:NEWTON WELLESLEY CARDIOLOGISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-675-4683
Mailing Address - Street 1:6 LAKEVILLE BUSINESS PARK
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-1234
Mailing Address - Country:US
Mailing Address - Phone:508-675-4683
Mailing Address - Fax:508-675-7905
Practice Address - Street 1:2000 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1650
Practice Address - Country:US
Practice Address - Phone:617-527-1335
Practice Address - Fax:617-244-9841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9766049Medicaid
MAM15390OtherBCBS OF MA
M15390Medicare ID - Type Unspecified