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General NPI Number Information
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NPI Number | 1891754883
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Entity Type | Organization
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Legal Business Name | DVA HEALTHCARE OF MASSACHUSETTS INC
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Dates
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Enumeration Date | 03/20/2006
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 10 CABOT RD STE 103B
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City | MEDFORD
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State | MA
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Zip | 02155-5275
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Country | US
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Telephone | 781-306-9740
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Fax | 781-306-9745
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Provider Business Mailing Address
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Address Line | 5200 VIRGINIA WAY ATT: L&C DEPT
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City | BRENTWOOD
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State | TN
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Zip | 37027-7569
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP LICENSURE & CERTIFICATION
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Name | SAMUEL T WEY
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Credential |
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Telephone | 615-341-6641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | EQ1D
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License Number State | MA
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