MEDICARE: MR. NEIL TRAHAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246Z00000X	Other Specialist/Technologist

General Provider Information

NPI Number	:	1154532372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NEIL TRAHAN

Provider Business Mailing Address
First Line	:	53 SUNRISE AVE
Second Line	:
City	:	GRAFTON
State	:	MA
Zip	:	01519-1000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	53 SUNRISE AVE
Second Line	:
City	:	GRAFTON
State	:	MA
Zip	:	01519-1000
Country	:	US
Telephone Number	:	508-277-3509
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2007
Last Update Date	:	07/08/2007

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