MEDICARE: BROCKTON UROLOGY CLINIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician		MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336147438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROCKTON UROLOGY CLINIC INC

Provider Business Mailing Address
First Line	:	340 MAIN ST
Second Line	:	SUITE 670
City	:	WORCESTER
State	:	MA
Zip	:	01608-1604
Country	:	US
Telephone Number	:	508-754-3566
Fax Number	:	508-798-8012

Provider Business Practice Location Address
First Line	:	31 ROCHE BROS WAY
Second Line	:	SUITE 100
City	:	NORTH EASTON
State	:	MA
Zip	:	02356-1032
Country	:	US
Telephone Number	:	508-238-0800
Fax Number	:	508-238-0882

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RICHARD B MCARDLE
Credential	:	MD
Telephone Number	:	508-583-4922

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/21/2022

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Directions to “BROCKTON UROLOGY CLINIC INC ” Practice Location

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