Healthcare Provider Details

I. General information

NPI: 1063923399
Provider Name (Legal Business Name): CONGENIAL HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 10/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 S MAIN ST
MIDDLETON MA
01949-2446
US

IV. Provider business mailing address

147 S MAIN ST
MIDDLETON MA
01949-2446
US

V. Phone/Fax

Practice location:
  • Phone: 978-774-2555
  • Fax:
Mailing address:
  • Phone: 978-774-2555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK ALLARA
Title or Position: PARTNER
Credential: MD
Phone: 978-774-2555