Provider Demographics
NPI:1902024292
Name:NEW ENGLAND CARDIOLOGY, L.L.C.
Entity Type:Organization
Organization Name:NEW ENGLAND CARDIOLOGY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVOR
Authorized Official - Middle Name:B
Authorized Official - Last Name:KVATERNIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-898-7622
Mailing Address - Street 1:25 MARSTON ST STE 404
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2359
Mailing Address - Country:US
Mailing Address - Phone:978-989-8911
Mailing Address - Fax:978-989-0748
Practice Address - Street 1:25 MARSTON ST STE 404
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2359
Practice Address - Country:US
Practice Address - Phone:978-989-8911
Practice Address - Fax:978-989-0748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30213126Medicaid
MAM17279OtherBLUE CROSS OF MA
NH30213125Medicaid
MA9787291Medicaid
NHNEWE117378OtherANTHEM BLUE CROSS OF NH
P92353Medicare UPIN
NHNEWE117378OtherANTHEM BLUE CROSS OF NH
A67928Medicare UPIN
NHRE5457Medicare ID - Type UnspecifiedGROUP NUMBER
MA9787291Medicaid
NH30213125Medicaid