MYSTIC VALLEY UROLOGICAL ASSOCIATES INC. NPI 1740295575

NPI Information

NPI: 1740295575
Provider Name: MYSTIC VALLEY UROLOGICAL ASSOCIATES INC.
Classification: Urology - 208800000X
Entity Type: Organization

CLIA Number: 22D0078984

Address:
3 WOODLAND RD
SUITE 216
STONEHAM, MA
ZIP 02180
Phone: (781) 979-0661
Get Directions

MYSTIC VALLEY UROLOGICAL ASSOCIATES INC. is an urology in Stoneham, MA. The provider is a urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. MYSTIC VALLEY UROLOGICAL ASSOCIATES INC. NPI is 1740295575. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3 WOODLAND RD
SUITE 216
STONEHAM, MA
ZIP 02180-702
Phone: (781) 979-0661
Fax: (781) 979-0372

The provider's authorized official is Marjie C Haluska .
The authorized official title is Director Of Business Operations and has the following contact phone number (781) 979-0661.

The CLIA number assigned to this NPI record is 22D0078984 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/30/2006 and was last updated on 11/7/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208800000X	Urology			MASSACHUSETTS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0009638	OTHER		NHP
2	M13568	MEDICARE UPIN	MASSACHUSETTS
3	600296	OTHER		TUFTS
4	CL0638	OTHER		RRMED
5	M13568	OTHER	MASSACHUSETTS	BCBSMA
6	9723757	MEDICAID	MASSACHUSETTS
7	0180650001	MEDICARE NSC	MASSACHUSETTS
8	28749	OTHER		FALLON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »