Healthcare Provider Details

I. General information

NPI: 1942450242
Provider Name (Legal Business Name): HALLMARK HEALTH MEDICAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 GOVERNORS AVE HALLMARK HEALTH MEDICAL ASSOCIATES INC (#2)-NON-PCHI
MEDFORD MA
02155-1643
US

IV. Provider business mailing address

PO BOX 3237 HALLMARK HEALTH MEDICAL ASSOCIATES INC (#2)-NON-PCHI
WOBURN MA
01888-3237
US

V. Phone/Fax

Practice location:
  • Phone: 781-338-7170
  • Fax: 781-338-7173
Mailing address:
  • Phone: 781-338-7170
  • Fax: 781-338-7173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL S TURILLI
Title or Position: VICE PRESIDENT FISCAL SERVICES
Credential:
Phone: 781-338-7415