Healthcare Provider Details

I. General information

NPI: 1275578809
Provider Name (Legal Business Name): URBAN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545A CENTRE ST
JAMAICA PLAIN MA
02130-2061
US

IV. Provider business mailing address

545A CENTRE ST
JAMAICA PLAIN MA
02130-2061
US

V. Phone/Fax

Practice location:
  • Phone: 617-522-5464
  • Fax: 617-524-2966
Mailing address:
  • Phone: 617-522-5464
  • Fax: 617-524-2966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: EMILY BROWER
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 617-522-5464