Healthcare Provider Details

I. General information

NPI: 1801215439
Provider Name (Legal Business Name): NASHOBA SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 WHALON ST SUITE 1D
FITCHBURG MA
01420-7128
US

IV. Provider business mailing address

104 WHALON ST SUITE 1D
FITCHBURG MA
01420-7128
US

V. Phone/Fax

Practice location:
  • Phone: 978-345-0050
  • Fax: 978-345-0064
Mailing address:
  • Phone: 978-345-0050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number74865
License Number StateMA

VIII. Authorized Official

Name: KENT GREENWOOD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 978-345-0050