Healthcare Provider Details

I. General information

NPI: 1831349984
Provider Name (Legal Business Name): NEW ENGLAND PAIN ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CONVERSE PL 4TH FLOOR
WINCHESTER MA
01890-2713
US

IV. Provider business mailing address

42 HEMINGWAY DR
RIVERSIDE RI
02915-2224
US

V. Phone/Fax

Practice location:
  • Phone: 781-729-0500
  • Fax: 781-729-0581
Mailing address:
  • Phone: 401-490-2130
  • Fax: 401-435-2483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateMA

VIII. Authorized Official

Name: FATHALLA MASHALI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 401-490-2130