Provider Demographics
NPI:1619129863
Name:CONCENTUS
Entity type:Organization
Organization Name:CONCENTUS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CASELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-842-6898
Mailing Address - Street 1:512 MAIN ST
Mailing Address - Street 2:PENTHOUSE
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-6405
Mailing Address - Country:US
Mailing Address - Phone:508-842-6898
Mailing Address - Fax:
Practice Address - Street 1:512 MAIN ST
Practice Address - Street 2:PENTHOUSE
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-6405
Practice Address - Country:US
Practice Address - Phone:508-842-6898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78863207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ14532Medicare PIN