MEDICARE: NEUROTECH INC

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	2084N0400X	Neurology Physician	46565	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	130002181	OTHER	MA	TRAVELERS MEDICARE
6	CM3196	OTHER	MA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	102375100	OTHER	MA	US DEPT OF LABOR
2	92688	OTHER	MA	AETNA US HEALTHACRE
3	C18116	OTHER	MA	BCBS
4	11151	OTHER	MA	HPHC NUMBER
7	VC6000170977	OTHER	MA	COMM OF MA
8	700883	OTHER	MA	TUFTS

General Provider Information

NPI Number	:	1225172851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROTECH INC

Provider Business Mailing Address
First Line	:	125 PARKER HILL AVE
Second Line	:	SUITE 300
City	:	BOSTON
State	:	MA
Zip	:	02120-2847
Country	:	US
Telephone Number	:	617-731-0016
Fax Number	:	617-739-6866

Provider Business Practice Location Address
First Line	:	125 PARKER HILL AVE
Second Line	:	SUITE 300
City	:	BOSTON
State	:	MA
Zip	:	02120-2847
Country	:	US
Telephone Number	:	617-731-0016
Fax Number	:	617-739-6866

Authorized Official
Title or Position	:	OWNER
Name	:	DEEPAK S TANDON
Credential	:	M.D.
Telephone Number	:	617-731-0016

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	04/24/2014

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Directions to “NEUROTECH INC ” Practice Location

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