Healthcare Provider Details

I. General information

NPI: 1568789527
Provider Name (Legal Business Name): HALLMARK HEALTH MEDICAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 GOVERNORS AVE ATTN: PROVIDER ENROLLMENT-HHMA (3) CONTACT
MEDFORD MA
02155-1643
US

IV. Provider business mailing address

PO BOX 3237 HALLMARK HEALTH MEDICAL ASSOCIATES INC (3)
WOBURN MA
01888-3237
US

V. Phone/Fax

Practice location:
  • Phone: 781-338-7521
  • Fax: 781-338-7531
Mailing address:
  • Phone: 781-338-7170
  • Fax: 781-338-7173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

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