Provider Demographics
NPI:1528261062
Name:DIANE P. KARALEKAS, M.D.,P.C.
Entity type:Organization
Organization Name:DIANE P. KARALEKAS, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRESOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-853-2020
Mailing Address - Street 1:591 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1901
Mailing Address - Country:US
Mailing Address - Phone:508-853-2020
Mailing Address - Fax:508-459-5082
Practice Address - Street 1:65 BOSTON POST ROAD
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752
Practice Address - Country:US
Practice Address - Phone:508-481-0815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81373207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA081373OtherTUFTS
MAM18958OtherBLUE CROSS BLUE SHIELD
MAPR62915710002OtherCIGNA CT GENERAL
MA151113OtherHARVARD PILGRIM
MA3140431Medicaid
MA0435353577OtherCIGNA CT GENERAL
MA23550OtherFALLON COMM HEALTH
MA0435353577OtherCIGNA CT GENERAL
MAM18958OtherBLUE CROSS BLUE SHIELD
MA=========OtherUNITED HEALTH CARE