Healthcare Provider Details

I. General information

NPI: 1184066912
Provider Name (Legal Business Name): HALLMARK HEALTH URGENT CARE PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 NEW CROSSING RD
READING MA
01867-3270
US

IV. Provider business mailing address

PO BOX 418699
BOSTON MA
02241-8699
US

V. Phone/Fax

Practice location:
  • Phone: 781-280-1699
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: ELIJAH BERG
Title or Position: PRESIDENT
Credential: MD
Phone: 781-280-1520