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General NPI Number Information
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NPI Number | 1801215439
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Entity Type | Organization
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Legal Business Name | NASHOBA SURGICAL ASSOCIATES
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Dates
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Enumeration Date | 04/10/2014
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Last Update Date | 04/10/2014
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Provider Practice Location Address
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Address Line | 104 WHALON ST SUITE 1D
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City | FITCHBURG
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State | MA
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Zip | 01420-7128
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Country | US
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Telephone | 978-345-0050
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Fax | 978-345-0064
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Provider Business Mailing Address
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Address Line | 104 WHALON ST SUITE 1D
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City | FITCHBURG
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State | MA
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Zip | 01420-7128
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Country | US
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Telephone | 978-345-0050
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENT GREENWOOD
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Credential | M.D.
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Telephone | 978-345-0050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 74865
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License Number State | MA
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