Healthcare Provider Details

I. General information

NPI: 1306209382
Provider Name (Legal Business Name): UMS LITHOTRIPSY SERVICES OF CENTRAL MASSACHUSETTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 05/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 W PARK DR SUITE 410
WESTBOROUGH MA
01581-3939
US

IV. Provider business mailing address

1700 W PARK DR SUITE 410
WESTBOROUGH MA
01581-3939
US

V. Phone/Fax

Practice location:
  • Phone: 703-955-4923
  • Fax: 571-313-0262
Mailing address:
  • Phone: 703-955-4923
  • Fax: 571-313-0262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QL0400X
TaxonomyLithotripsy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUSANNE TALEBIAN
Title or Position: BUSINESS MANAGER
Credential:
Phone: 703-955-4923