Healthcare Provider Details

I. General information

NPI: 1063630366
Provider Name (Legal Business Name): CAMBRIDGE HOSP PROF SER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1493 CAMBRIDGE ST
CAMBRIDGE MA
02139-1047
US

IV. Provider business mailing address

110 WINN ST SUITE 105
WOBURN MA
01801-2897
US

V. Phone/Fax

Practice location:
  • Phone: 781-933-3734
  • Fax: 781-932-3278
Mailing address:
  • Phone: 781-933-3734
  • Fax: 781-932-3278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS RUTH D'AGOSTINO
Title or Position: CEO BILLING
Credential:
Phone: 781-933-3734