Healthcare Provider Details

I. General information

NPI: 1104689686
Provider Name (Legal Business Name): NAMV MGBH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CLARK RD FL 2
TEWKSBURY MA
01876-1699
US

IV. Provider business mailing address

600 CLARK RD FL 2
TEWKSBURY MA
01876-1699
US

V. Phone/Fax

Practice location:
  • Phone: 978-453-1811
  • Fax:
Mailing address:
  • Phone: 978-453-1811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DOUGLAS MESLER
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 978-453-1811