# DEDHAM MEDICAL ASSOC INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326064312
- **Authorized official:** MR. RICHARD M RUSSO (CFO)
- **Authorized official phone:** (781) 278-5540

## Contact information

- **Practice address:** ONE LYONS STREET, DEDHAM, MA 02026
- **Practice address phone:** (781) 329-1400
- **Practice address fax:** (781) 278-5667
- **Mailing address:** PO BOX 9120, DEDHAM, MA 02027-9120
- **Mailing address phone:** (781) 329-1400
- **Mailing address fax:** (781) 278-5667

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | TAX ID | MA | Yes |

## Other

- **Enumeration date:** 07/14/2006
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 9766529 | — | MA |
| 05 | — | 9766537 | — | MA |
| 05 | — | 9766545 | — | MA |
| 05 | — | 9766553 | — | MA |
| 05 | — | 9766561 | — | MA |
| 05 | — | 9766588 | — | MA |
| 05 | — | 9766596 | — | MA |
| 05 | — | 9766626 | — | MA |
| 05 | — | 9766634 | — | MA |
| 05 | — | 97666618 | — | MA |