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General NPI Number Information
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NPI Number | 1073660015
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Entity Type | Organization
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Legal Business Name | RAD RHEUMATOLOGY & AUTOIMMUNE DISORDERS LLC
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 02/06/2014
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Provider Practice Location Address
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Address Line | 851 MAIN ST SUITE 14
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City | S WEYMOUTH
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State | MA
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Zip | 02190-1612
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Country | US
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Telephone | 508-822-2874
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Fax | 508-880-0450
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Provider Business Mailing Address
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Address Line | 851 MAIN ST SUITE 14
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City | S WEYMOUTH
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State | MA
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Zip | 02190-1612
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Country | US
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Telephone | 508-822-2874
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Fax | 508-880-0450
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALEKSANDER FEOKTISTOV
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Credential | M.D.
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Telephone | 508-822-2874
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 211533
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License Number State | MA
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