Basic Information
Provider Information
NPI: 1194074997
EntityType: 2
ReplacementNPI:  
OrganizationName: ATRIUS HEALTH, INC.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: HARVARD VANGUARD MEDICAL ASSOCIATES
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 275 GROVE ST
Address2: SUITE 3-300
City: AUBURNDALE
State: MA
PostalCode: 024662272
CountryCode: US
TelephoneNumber: 6175598374
FaxNumber: 6174213487
Practice Location
Address1: 152 2ND AVE
Address2: NEEDHAM CENTRAL LABORATORY - HVMA
City: NEEDHAM
State: MA
PostalCode: 024942809
CountryCode: US
TelephoneNumber: 6174213525
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/07/2012
LastUpdateDate: 06/20/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: STRONGWATER
AuthorizedOfficialFirstName: STEVE
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 6175598042
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/20/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
291U00000X  Y LaboratoriesClinical Medical Laboratory 

No ID Information.


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