Healthcare Provider Details

I. General information

NPI: 1306238449
Provider Name (Legal Business Name): UMASS MEMORIAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2015
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LAKE AVE N
WORCESTER MA
01655-0002
US

IV. Provider business mailing address

365 PLANTATION ST
WORCESTER MA
01605-2397
US

V. Phone/Fax

Practice location:
  • Phone: 508-334-1501
  • Fax: 508-334-1964
Mailing address:
  • Phone: 58-334-1501
  • Fax: 508-334-1964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
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: MR. SERGIO MELGAR
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 508-344-1501