Healthcare Provider Details

I. General information

NPI: 1851584379
Provider Name (Legal Business Name): WALTHAM DIABETES CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 WESTON ST WALTHAM DIABETES CENTER SUITE 8
WALTHAM MA
02453-7756
US

IV. Provider business mailing address

42 WESTON ST WALTHAM DIABETES CENTER SUITE 8
WALTHAM MA
02453-7756
US

V. Phone/Fax

Practice location:
  • Phone: 781-647-7220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN M SCHRODER
Title or Position: PRESIDENT
Credential:
Phone: 781-647-7220