Healthcare Provider Details

I. General information

NPI: 1093922189
Provider Name (Legal Business Name): CHARLES RIVER ENDOSCOPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

297 UNION AVE
FRAMINGHAM MA
01702-6337
US

IV. Provider business mailing address

171 MAIN ST SUITE 203
ASHLAND MA
01721-1187
US

V. Phone/Fax

Practice location:
  • Phone: 508-665-4110
  • Fax: 508-665-4111
Mailing address:
  • Phone: 508-881-3029
  • Fax: 508-881-1752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. VINAY KUMAR
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 508-881-3029