Healthcare Provider Details

I. General information

NPI: 1861279705
Provider Name (Legal Business Name): FIREFLY MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 ARSENAL PL
WATERTOWN MA
02472-3171
US

IV. Provider business mailing address

PO BOX 211639
EAGAN MN
55121-3639
US

V. Phone/Fax

Practice location:
  • Phone: 888-897-1887
  • Fax: 857-343-8192
Mailing address:
  • Phone: 888-897-1887
  • Fax: 857-343-8192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY O GREENBERG
Title or Position: CLINICIAN
Credential: MD
Phone: 781-291-3042