Healthcare Provider Details

I. General information

NPI: 1861064719
Provider Name (Legal Business Name): RMCCM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 NEWBURY ST FL 5
BOSTON MA
02115-2738
US

IV. Provider business mailing address

5 CABOT RD UNIT 161
MEDFORD MA
02155-5298
US

V. Phone/Fax

Practice location:
  • Phone: 408-717-0841
  • Fax:
Mailing address:
  • Phone: 408-717-0841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: RAHUL SHARMA
Title or Position: CEO
Credential:
Phone: 408-717-0841