MEDICARE: DHA ENDOSCOPY LLC

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	261QA1903X	Ambulatory Surgical Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	909753	OTHER	MA	HARVARD PILGRIM HEALTH
2	661985	OTHER	MA	TUFTS HEALTH PLANS
3	M88039	OTHER	MA	BLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number	:	1730113325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DHA ENDOSCOPY LLC

Provider Business Mailing Address
First Line	:	91 MONTVALE AVE STE 103
Second Line	:
City	:	STONEHAM
State	:	MA
Zip	:	02180-3649
Country	:	US
Telephone Number	:	781-835-2111
Fax Number	:	781-438-4829

Provider Business Practice Location Address
First Line	:	91 MONTVALE AVE STE 103
Second Line	:
City	:	STONEHAM
State	:	MA
Zip	:	02180-3649
Country	:	US
Telephone Number	:	781-835-2111
Fax Number	:	781-438-4829

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JULIE B HILL
Credential	:
Telephone Number	:	781-835-2111

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	11/04/2025

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Directions to “DHA ENDOSCOPY LLC ” Practice Location

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