RODERICK H CROCKER JR. (NPI# 1053310367) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053310367 |
| Entity Type | Individual |
| Full Name | RODERICK H CROCKER JR. |
| Credential | MD |
| Practice Address |
300 Mount Auburn St Ste 519 Cambridge MA 02138-5600 |
| Mailing Address |
300 Mount Auburn Street, Suite #519 Cambridge MA 02138-5600 |
| Practice Telephone | 6175474400 |
| Practice Fax Number | 6175761076 |
| Mailing Telephone | 6175474400 |
| Mailing Fax Number | 6175761076 |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2016-06-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | 55453 | MA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | 3009700 | 05 |
| Street Address |
300 MOUNT AUBURN ST STE 519 |
| City | CAMBRIDGE |
| State | MA |
| Zip Code | 02138-5600 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568466316 | Frederick W Ruymann | Internal Medicine | 300 Mount Auburn St, Ste 405, Cambridge, MA 02138-5665 | 2005-06-09 |
| 1134688120 | Peymaan Sam Banankhah | Internal Medicine | 300 Mount Auburn St, Cambridge, MA 02138-5600 | 2019-03-18 |
| 1508389636 | Emily Holmes | Nurse Practitioner | 300 Mount Auburn St, Cambridge, MA 02138-5600 | 2017-07-20 |
| 1396277455 | Dr. Susan Pories | Surgery | 300 Mount Auburn St, Suite 509, Cambridge, MA 02138-5600 | 2017-03-29 |
| 1992243554 | Allison Vandermeulen | Specialist/Technologist, Other | 300 Mount Auburn St, Suite 505, Cambridge, MA 02138-5600 | 2017-02-03 |
| 1982142519 | Jessica Jeanne Sullivan | Registered Nurse | 300 Mount Auburn St, Cambridge, MA 02138-5600 | 2017-02-02 |
| 1578017497 | Andrew Dallahan Donnelly | Registered Nurse | 300 Mount Auburn St, Suite 517, Cambridge, MA 02138-5600 | 2016-08-09 |
| 1447634670 | Troy Tweiten | Internal Medicine | 300 Mount Auburn St, Cambridge, MA 02138-5600 | 2015-07-17 |
| 1235528696 | Laura Boldyrev | Nurse Practitioner | 300 Mount Auburn St, Suite 509, Cambridge, MA 02138-5600 | 2015-01-22 |
| 1649673724 | Cambridge Digestive Health PC | Internal Medicine | 300 Mount Auburn St, Suite 405, Cambridge, MA 02138-5600 | 2014-10-02 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922618610 | Khushboo Vijay Bhatia | Student in an Organized Health Care Education/Training Program | Internal Medicine Residency Program, Mount Auburn Hospi, 330 Mt. Auburn Street, Cambridge, MA 02138 | 2020-08-06 |
| 1780204156 | Ashna Grover | Student in an Organized Health Care Education/Training Program | 330 Mt Auburn Street Mount Auburn Hospital, Internal Medicine Residency Program, Cambridge, MA 02138 | 2020-04-25 |
| 1790330298 | Cambridge Periodontics LLC | Dentist | 1692 Massachusetts Ave Ste 3, Cambridge, MA 02138 | 2019-08-02 |
| 1295389765 | Yulia Levit | Technician/Technologist | 1208 Massachussets Av, Cambridge, MA 02138 | 2019-08-01 |
| 1720645393 | Chinmay Tusharkumar Jani | Student in an Organized Health Care Education/Training Program | Mount Auburn Hospital, 330 Mt Auburn Street, Cambridge, MA 02138 | 2019-05-20 |
| 1386209831 | Alexander Ryan Walker | Internal Medicine | 300 Mount Auburn Street Mount Auburn Hospital, Dept. of Medicine, Cambridge, MA 02138 | 2019-05-09 |
| 1659844868 | Aimee Hsieh | Social Worker | 525 Mount Auburn Street, Cambridge, MA 02138 | 2019-01-10 |
| 1043733389 | Armida Fruzzetti | Psychologist | 900 Concord Avenue, Cambridge, MA 02138 | 2017-07-19 |
| 1174984827 | Jenna Mezin Schmid | Psychologist | 75 Mt Auburn St 4 East, Harvard University Health Services, Cambridge, MA 02138 | 2016-03-09 |
| 1316313208 | Kelly Abbott | Optometrist | 12 Eliot St., Cambridge, MA 02138 | 2015-08-14 |
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| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| 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. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619464781 | Osama Alalao | Urology | 655 Concord Ave Apt 702, Cambridge, MA 02138-1086 | 2018-04-15 |
| 1225037518 | George B Reservitz | Urology | 300 Mt. Auburn Street, Suite 519, Suite 519, Cambridge, MA 02138-5600 | 2005-07-19 |
| 1598772709 | Thomas M Picklow | Urology | 1200 Clark St, Cambridge, OH 43725-9611 | 2006-08-01 |
| 1689626681 | Clifford Maximo | Urology | 1200 Clark St, Cambridge, OH 43725-9611 | 2006-05-17 |
| 1346212404 | Louis S Liou | Urology | 1493 Cambridge St, Cambridge, MA 02139-1047 | 2006-02-03 |
| 1730188038 | James C Ku | Urology | 300 Mount Auburn St, Suite 519, Cambridge, MA 02138-5600 | 2005-07-19 |
| 1164421467 | Cambridge Urological Associates, Inc. | Urology | 300 Mount Auburn St, Ste 519, Cambridge, MA 02138-5600 | 2005-07-19 |
| 1851390165 | Paul D Lafontaine | Urology | 300 Mount Auburn St, Ste 519, Cambridge, MA 02138-5600 | 2005-07-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568099737 | Kelly Lindert | Urology | 68 Chester St, Arlington, MA 02476-7607 | 2020-03-26 |
| 1043710791 | Beth Israel Lahey Health Primary Care, Inc. | Urology | Lahey Institute of Urology, Beverly, 41 Mall Rd., Burlington, MA 01805 | 2018-02-20 |
| 1366983322 | Beth Israel Lahey Health Primary Care, Inc. | Urology | Lahey Physician Community I Inc, 41 Mall Rd., Burlington, MA 01805-0001 | 2017-03-10 |
| 1447707450 | Yonah Krakowsky | Urology | 200 Boylston St # A309, Chestnut Hill, MA 02467-2012 | 2016-09-07 |
| 1952796518 | Filipe La Fuente De Carvalho | Urology | 55 Fruit St Dept of Urology, Boston, MA 02114-2621 | 2015-03-31 |
| 1487087375 | Abdulsalam Ahmed Albalawi | Urology | 88 Thornton Rd, 88, Chestnut Hill, MA 02467-3611 | 2013-08-14 |
| 1083955538 | Eugene Blanchard Cone | Urology | 55 Fruit St - Grb 1100, Massachusetts General Hospital - Department of Urology, Boston, MA 02114 | 2013-03-08 |
| 1881946929 | David T Mahony | Urology | 223 Fairview Ave, Brockton, MA 02301-2907 | 2012-10-14 |
| 1710240395 | Chintan Patel | Urology | 85 Prescott St Ste 403, Worcester, MA 01605-2671 | 2012-06-19 |
| 1922374636 | Stefan Karos Mdpc | Urology | 50 Memorial Dr Ste 104, Leominster, MA 01453-2238 | 2012-03-27 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.