Basic Information
| Provider Information | |||||||||
| NPI: | 1891907366 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HARVARD VANGUARD MEDICAL ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 275 GROVE STREET | ||||||||
| Address2: | SUITE 3-300 | ||||||||
| City: | NEWTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5175598374 | ||||||||
| FaxNumber: | 6174213487 | ||||||||
| Practice Location | |||||||||
| Address1: | 1153 CENTRE ST | ||||||||
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| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175227041 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2007 | ||||||||
| LastUpdateDate: | 07/12/2010 | ||||||||
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| AuthorizedOfficialLastName: | LINDSEY | ||||||||
| AuthorizedOfficialFirstName: | H. EUGENE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6175598260 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 208600000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0033418 | 01 | MA | NEIGHBORHOOD HEALTH PLAN | OTHER | M18801 | 01 | MA | BLUE CROSS BLUE SHIELD | OTHER |