Healthcare Provider Details

I. General information

NPI: 1235128737
Provider Name (Legal Business Name): MASSACHUSETTS DEVELOPMENT FINANCE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 JACKSON RD
DEVENS MA
01434-5062
US

IV. Provider business mailing address

9 MAIN ST SUITE 2K
SUTTON MA
01590-1660
US

V. Phone/Fax

Practice location:
  • Phone: 800-488-4351
  • Fax: 978-772-8819
Mailing address:
  • Phone: 866-268-5200
  • Fax: 508-476-9748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number3050
License Number StateMA

VIII. Authorized Official

Name: JOSEPH LEBLANC
Title or Position: CHIEF
Credential:
Phone: 978-772-4600