Healthcare Provider Details

I. General information

NPI: 1093670515
Provider Name (Legal Business Name): UMASS MEMORIAL MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 WEST ST STE 10
MILFORD MA
01757-2274
US

IV. Provider business mailing address

P.O. BOX 415348 ATTN: PROVIDER ENROLLMENT
BOSTON MA
02241
US

V. Phone/Fax

Practice location:
  • Phone: 508-381-6590
  • Fax: 508-381-6593
Mailing address:
  • Phone: 508-334-8015
  • Fax: 508-334-8105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREW SCIANNAMEO
Title or Position: DIRECTOR, MEDICAL STAFF SERVICES
Credential:
Phone: 508-450-0098