Healthcare Provider Details

I. General information

NPI: 1548079080
Provider Name (Legal Business Name): REGAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 PARK AVE STE 400
WORCESTER MA
01609-1989
US

IV. Provider business mailing address

255 PARK AVE STE 400
WORCESTER MA
01609-1989
US

V. Phone/Fax

Practice location:
  • Phone: 508-755-9776
  • Fax: 508-793-0715
Mailing address:
  • Phone: 508-755-9776
  • Fax: 508-831-7861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AL NAWAB
Title or Position: DIRECTOR
Credential:
Phone: 508-925-0073