Healthcare Provider Details

I. General information

NPI: 1750677720
Provider Name (Legal Business Name): CENTRAL MASS PULMONARY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 LEOMINSTER RD
STERLING MA
01564-2146
US

IV. Provider business mailing address

PO BOX 415348
BOSTON MA
02241-5348
US

V. Phone/Fax

Practice location:
  • Phone: 978-422-5082
  • Fax: 978-422-5081
Mailing address:
  • Phone: 800-225-8885
  • Fax: 508-334-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number159715
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number159715
License Number StateMA

VIII. Authorized Official

Name: DR. ODALYS CROTEAU
Title or Position: OWNER
Credential: M.D.
Phone: 978-669-5684