Basic Information
| Provider Information | |||||||||
| NPI: | 1710008982 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATED INTERNISTS OF RANDOLPH, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 108 BREAKWATER SHORES DR | ||||||||
| Address2: | |||||||||
| City: | HYANNIS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026014800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087908219 | ||||||||
| FaxNumber: | 5085349950 | ||||||||
| Practice Location | |||||||||
| Address1: | NEW ENGLAND SINAI HOSPITAL | ||||||||
| Address2: | 250 YORK STREET | ||||||||
| City: | STOUGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813440600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ROOS | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5088018330 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 32453 | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.