Provider Demographics
NPI:1902907652
Name:PERSONAL DIALYSIS, INC.
Entity Type:Organization
Organization Name:PERSONAL DIALYSIS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-932-8891
Mailing Address - Street 1:400 W CUMMINGS PARK
Mailing Address - Street 2:SUITE 2250
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-6519
Mailing Address - Country:US
Mailing Address - Phone:781-932-8891
Mailing Address - Fax:617-783-0255
Practice Address - Street 1:747 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2926
Practice Address - Country:US
Practice Address - Phone:617-783-3800
Practice Address - Fax:617-783-0255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAEQZF261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA93942OtherFALLON HEALTHCARE PROV NO
MAAA33419OtherHPHC PAYEE ID
MA1316303Medicaid
MAAA33419OtherHPHC PAYEE ID