Organization
MYSTIC VALLEY UROLOGICAL ASSOC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARJIE HALUSKA (DIRECTOR OF BUSINESS OPERATIONS)
(781) 979-0661
Entity
Organization
Contact information
Practice address
3 WOODLAND RD, SUITE 216, STONEHAM, MA 02180-1702
(781) 979-0661
(781) 979-0372
Mailing address
3 WOODLAND RD, SUITE 216, STONEHAM, MA 02180-1702
(781) 979-0661
(781) 979-0372
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0009638
NHP
MA
01
—
28749
FALLON
MA
01
—
600296
TUFTS
MA
01
—
9723757
NETWORK HEALTH
MA
05
—
9723757
—
MA
01
—
CL0638
RRMED
MA
01
—
M13568
BCBSMA
MA
Enumeration date
12/17/2009
Last updated
01/13/2011
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