| NPI | 1073725990 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER MELENCIO Billing Agent 508-620-2800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine Cardiovascular Disease (Licence: MA NOT APPLICABLE) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2020-08-22 |