Healthcare Provider Details

I. General information

NPI: 1528103025
Provider Name (Legal Business Name): RELIANT MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N LAKE AVE
WORCESTER MA
01605-2047
US

IV. Provider business mailing address

630 PLANTATION ST, WOT 12TH FL ATTN: MEDICAL STAFF SERVICES
WORCESTER MA
01605-2038
US

V. Phone/Fax

Practice location:
  • Phone: 508-852-0600
  • Fax:
Mailing address:
  • Phone: 508-368-5424
  • Fax: 508-368-5530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ROBIN RICHMAN
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 508-852-0600