Healthcare Provider Details

I. General information

NPI: 1275734535
Provider Name (Legal Business Name): MARLBOROUGH CENTER FOR SLEEP DISORDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 BOLTON ST SUITE 100
MARLBOROUGH MA
01752-3980
US

IV. Provider business mailing address

320 BOLTON ST SUITE 100
MARLBOROUGH MA
01752-3980
US

V. Phone/Fax

Practice location:
  • Phone: 508-481-4288
  • Fax: 508-624-7228
Mailing address:
  • Phone: 508-481-4288
  • Fax: 508-624-7228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number47576
License Number StateMA

VIII. Authorized Official

Name: DR. CLIFFORD GEORGE RISK
Title or Position: OWNER
Credential: M.D.,PH.D.
Phone: 508-481-4288