MEDICARE: METROWEST VASCULAR PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M17754	OTHER	MA	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	690448	OTHER	MA	TUFTS

General Provider Information

NPI Number	:	1033108576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METROWEST VASCULAR PC

Provider Business Mailing Address
First Line	:	460 TOTTEN POND RD
Second Line	:	MZI
City	:	WALTHAM
State	:	MA
Zip	:	02451-1991
Country	:	US
Telephone Number	:	781-890-9933
Fax Number	:	781-890-9950

Provider Business Practice Location Address
First Line	:	67 UNION ST
Second Line	:
City	:	NATICK
State	:	MA
Zip	:	01760-7700
Country	:	US
Telephone Number	:	508-655-8900
Fax Number	:	508-650-7926

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ARNOLD MILLER
Credential	:	MD
Telephone Number	:	508-655-8900

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	08/22/2020

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Directions to “METROWEST VASCULAR PC ” Practice Location

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