Healthcare Provider Details

I. General information

NPI: 1326582206
Provider Name (Legal Business Name): TELLINMEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2016
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 ELM STREET SUITE 1
NORTH ATTLEBORO MA
02760
US

IV. Provider business mailing address

380 ELM ST STE 1
NORTH ATTLEBORO MA
02760-3314
US

V. Phone/Fax

Practice location:
  • Phone: 508-682-1686
  • Fax:
Mailing address:
  • Phone: 774-643-6261
  • Fax: 774-643-6358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number245843
License Number StateMA

VIII. Authorized Official

Name: JASPER I NGMONBA
Title or Position: GROUP OWNER
Credential: MD
Phone: 617-513-1446