Healthcare Provider Details

I. General information

NPI: 1174765200
Provider Name (Legal Business Name): CARITAS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 WARREN ST SUITE 339
BRIGHTON MA
02135-3601
US

IV. Provider business mailing address

77 WARREN ST SUITE 339
BRIGHTON MA
02135-3601
US

V. Phone/Fax

Practice location:
  • Phone: 617-519-5355
  • Fax:
Mailing address:
  • Phone: 617-519-5355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. CINDY J MORAN
Title or Position: DIRECTOR OF PHYSICIAN REVENUE CYCLE
Credential:
Phone: 617-562-5338