Healthcare Provider Details

I. General information

NPI: 1225010846
Provider Name (Legal Business Name): TWINBROOK SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 HOPE AVE STE 207
WALTHAM MA
02453-2721
US

IV. Provider business mailing address

20 HOPE AVE STE 207
WALTHAM MA
02453-2721
US

V. Phone/Fax

Practice location:
  • Phone: 781-893-6520
  • Fax: 781-893-6522
Mailing address:
  • Phone: 781-893-6520
  • Fax: 781-893-6522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS JOSEPH GRADY
Title or Position: PRESIDENT
Credential: M D
Phone: 781-893-6520