Healthcare Provider Details

I. General information

NPI: 1003951260
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: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 PLANTATION ST
WORCESTER MA
01605-2038
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 TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

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