=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528261062
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIANE P. KARALEKAS, M.D.,P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2007
-----------------------------------------------------
Last Update Date | 12/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 65 BOSTON POST ROAD
-----------------------------------------------------
City | MARLBOROUGH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-481-0815
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 591 LINCOLN ST
-----------------------------------------------------
City | WORCESTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01605-1901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-853-2020
-----------------------------------------------------
Fax | 508-459-5082
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING COORDINATOR
-----------------------------------------------------
Name | ANITA FRESOLO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 508-853-2020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 81373
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------