=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073725990
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRAMINGHAM CARDIOLOGY DIAGNOSTICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 LINCOLN STREET METROWEST MEDICAL CENTER
-----------------------------------------------------
City | FRAMINGHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-879-6026
-----------------------------------------------------
Fax | 508-879-8958
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 680 WORCESTER ROAD
-----------------------------------------------------
City | FRAMINGHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01702-5259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-620-2800
-----------------------------------------------------
Fax | 508-620-2808
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING AGENT
-----------------------------------------------------
Name | PETER MELENCIO
-----------------------------------------------------
Credential | CPA
-----------------------------------------------------
Telephone | 508-620-2800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | NOT APPLICABLE
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------