Healthcare Provider Details

I. General information

NPI: 1548307598
Provider Name (Legal Business Name): COMMUNITY INTERNIST ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 MONTVALE AVENUE SUITE 2200
STONEHAM MA
02180-3636
US

IV. Provider business mailing address

92 MONTVALE AVENUE SUITE 2200
STONEHAM MA
02180-3636
US

V. Phone/Fax

Practice location:
  • Phone: 781-279-2030
  • Fax: 781-279-2078
Mailing address:
  • Phone: 781-279-2030
  • Fax: 781-279-2078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number40952
License Number StateMA

VIII. Authorized Official

Name: KANU O PATEL
Title or Position: PRESIDENT
Credential: MD
Phone: 781-279-2030