Healthcare Provider Details

I. General information

NPI: 1598204281
Provider Name (Legal Business Name): MSA WHPHO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 MAIN ST SUITE G2A
WINCHESTER MA
01890-1961
US

IV. Provider business mailing address

955 MAIN ST SUITE G2A
WINCHESTER MA
01890-1961
US

V. Phone/Fax

Practice location:
  • Phone: 781-729-2020
  • Fax: 781-729-6846
Mailing address:
  • Phone: 781-729-2020
  • Fax: 781-729-6846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RICK WHITE
Title or Position: BUSINESS MANAGER
Credential:
Phone: 781-729-2020