Healthcare Provider Details

I. General information

NPI: 1245200021
Provider Name (Legal Business Name): MADALON MEANY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 MOUNT AUBURN ST WALK-IN CENTER
CAMBRIDGE MA
02138-5502
US

IV. Provider business mailing address

330 MOUNT AUBURN ST WALK-IN CENTER
CAMBRIDGE MA
02138-5502
US

V. Phone/Fax

Practice location:
  • Phone: 617-499-5065
  • Fax: 617-499-5686
Mailing address:
  • Phone: 617-499-5065
  • Fax: 617-499-5686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number60438
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: