Provider Demographics
NPI:1538373295
Name:HARVARD VANGUARD MEDICAL ASSOCIATES, INC
Entity type:Organization
Organization Name:HARVARD VANGUARD MEDICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-559-8393
Mailing Address - Street 1:275 GROVE STREET
Mailing Address - Street 2:SUITE 3-300
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02466
Mailing Address - Country:US
Mailing Address - Phone:617-559-8374
Mailing Address - Fax:617-421-3487
Practice Address - Street 1:2 ESSEX CENTER DR
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2902
Practice Address - Country:US
Practice Address - Phone:978-532-2800
Practice Address - Fax:978-977-4226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0029501OtherNEIGHBORHOOD HEALTH PLAN
MAM18223OtherBLUE CROSS BLUE SHIELD
MAM18223OtherBLUE CROSS BLUE SHIELD
MA0029501OtherNEIGHBORHOOD HEALTH PLAN
MAPT0139Medicare PIN