Provider Demographics
NPI:1649375304
Name:NORFOLK COUNTY CARDIOLOGY ASSOC
Entity type:Organization
Organization Name:NORFOLK COUNTY CARDIOLOGY ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-384-2500
Mailing Address - Street 1:844 FRANKLIN STREET
Mailing Address - Street 2:#4
Mailing Address - City:WRENTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02093
Mailing Address - Country:US
Mailing Address - Phone:508-384-2500
Mailing Address - Fax:508-384-9410
Practice Address - Street 1:844 FRANKLIN STREET
Practice Address - Street 2:#4
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093
Practice Address - Country:US
Practice Address - Phone:508-384-2500
Practice Address - Fax:508-384-9410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM16056OtherBCBS
MA603275OtherTUFTS
MA9775471Medicaid
MAM16056Medicare ID - Type Unspecified