Healthcare Provider Details

I. General information

NPI: 1871846428
Provider Name (Legal Business Name): RELIANT MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2012
Last Update Date: 11/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 BOYDEN RD
HOLDEN MA
01520-2570
US

IV. Provider business mailing address

5 NEPONSET ST
WORCESTER MA
01606-2714
US

V. Phone/Fax

Practice location:
  • Phone: 508-856-9599
  • Fax: 508-829-4988
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: TAREK ELSAWY
Title or Position: PRESIDENT & CEO
Credential: MD
Phone: 508-852-0600