Healthcare Provider Details

I. General information

NPI: 1235494865
Provider Name (Legal Business Name): MADDIES MOBILE HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 NEWCOMB AVE
RANDOLPH MA
02368-2654
US

IV. Provider business mailing address

76 NEWCOMB AVE
RANDOLPH MA
02368-2654
US

V. Phone/Fax

Practice location:
  • Phone: 781-885-7338
  • Fax:
Mailing address:
  • Phone: 781-885-7338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberS10040837
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number1714303
License Number StateMA

VIII. Authorized Official

Name: MRS. MADELINE C. FIORINO
Title or Position: OWNER
Credential: RMA /CARDIO PHLEBOTO
Phone: 781-885-7338