Healthcare Provider Details

I. General information

NPI: 1689360844
Provider Name (Legal Business Name): MAGDALENA MARTA EID MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CORPORATE PARK DR
PEMBROKE MA
02359-1966
US

IV. Provider business mailing address

15 CORPORATE PARK DR
PEMBROKE MA
02359-1966
US

V. Phone/Fax

Practice location:
  • Phone: 844-783-3736
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1027027
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: