Healthcare Provider Details

I. General information

NPI: 1184812620
Provider Name (Legal Business Name): RELIANT MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SUMMER STREET
WORCESTER MA
01608-1216
US

IV. Provider business mailing address

630 PLANTATION ST WOT 12TH FL
WORCESTER MA
01605-2038
US

V. Phone/Fax

Practice location:
  • Phone: 508-368-3103
  • Fax: 508-368-3104
Mailing address:
  • Phone: 508-368-5424
  • Fax: 508-368-5530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: ROBIN RICHMAN
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 508-368-5561