Healthcare Provider Details

I. General information

NPI: 1013535632
Provider Name (Legal Business Name): ALZHEIMERS DISEASE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 MILLER ST FL 4
QUINCY MA
02169-4725
US

IV. Provider business mailing address

PO BOX 45555
WINTER HILL MA
02145-0009
US

V. Phone/Fax

Practice location:
  • Phone: 617-302-6388
  • Fax:
Mailing address:
  • Phone: 617-639-5006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MALINI NAIR
Title or Position: MD
Credential: MD
Phone: 617-639-5006