Provider Demographics
NPI:1962526764
Name:MUTO THORACIC CLINIC INCORPORATED
Entity type:Organization
Organization Name:MUTO THORACIC CLINIC INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-683-2217
Mailing Address - Street 1:100 AMESBURY STREET,
Mailing Address - Street 2:SUITE 113
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840
Mailing Address - Country:US
Mailing Address - Phone:978-683-2217
Mailing Address - Fax:978-689-0493
Practice Address - Street 1:100 AMESBURY STREET,
Practice Address - Street 2:SUITE 113
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840
Practice Address - Country:US
Practice Address - Phone:978-683-2217
Practice Address - Fax:978-689-0493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25701208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B76213Medicare UPIN