Healthcare Provider Details

I. General information

NPI: 1801398953
Provider Name (Legal Business Name): GENERA HEALTH DIRECT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 CHESTNUT ST STE 35
NEEDHAM MA
02492-2520
US

IV. Provider business mailing address

46 SUNSET RD
NEEDHAM HEIGHTS MA
02494-1452
US

V. Phone/Fax

Practice location:
  • Phone: 508-563-3003
  • Fax:
Mailing address:
  • Phone: 773-322-9949
  • Fax: 773-897-5905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number251722
License Number StateMA

VIII. Authorized Official

Name: MARGARITA C CASTRO-ZARRAGA
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 773-322-9949