Basic Information
| Provider Information | |||||||||
| NPI: | 1750677720 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL MASS PULMONARY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 415348 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022415348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002258885 | ||||||||
| FaxNumber: | 5083341977 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 LEOMINSTER RD | ||||||||
| Address2: | |||||||||
| City: | STERLING | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015642146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784225082 | ||||||||
| FaxNumber: | 9784225081 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2011 | ||||||||
| LastUpdateDate: | 03/14/2019 | ||||||||
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| AuthorizedOfficialLastName: | CROTEAU | ||||||||
| AuthorizedOfficialFirstName: | ODALYS | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9786695684 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RS0012X | 159715 | MA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207RC0200X | 159715 | MA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
No ID Information.