Organization
MINIMALLY INVASIVE THORACIC SURGERY ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PRODUYT K PODDAR MD (PRESIDENT)
(617) 257-5945
Entity
Organization
Contact information
Practice address
800 W CUMMINGS PARK, SUITE 4700, WOBURN, MA 01801-6372
(781) 932-6487
(781) 932-6486
Mailing address
340 MAIN ST, SUITE 670, WORCESTER, MA 01608-1604
(508) 454-3566
(508) 438-6368
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110083476A
—
MA
01
—
M19736
BCBS
MA
Enumeration date
05/05/2009
Last updated
12/06/2011
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