Healthcare Provider Details

I. General information

NPI: 1548308588
Provider Name (Legal Business Name): TAUNTON ATTLEBORO NEUROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 WINTHROP ST UNIT 6
REHOBOTH MA
02769
US

IV. Provider business mailing address

289 WINTHROP ST UNIT 6
REHOBOTH MA
02769
US

V. Phone/Fax

Practice location:
  • Phone: 508-252-9700
  • Fax: 508-252-9770
Mailing address:
  • Phone: 508-252-9700
  • Fax: 508-252-9770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number075634
License Number StateMA

VIII. Authorized Official

Name: JONATHAN WARREN MARTIN
Title or Position: OWNER
Credential: M.D.
Phone: 508-252-9700