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General NPI Number Information
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NPI Number | 1053510180
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Entity Type | Organization
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Legal Business Name | SUN MEDICAL CLINIC, PC
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 07/18/2007
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Provider Practice Location Address
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Address Line | 50 MEMORIAL DR SUITE 110
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City | LEOMINSTER
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State | MA
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Zip | 01453-2238
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Country | US
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Telephone | 978-840-0055
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Fax | 978-840-0063
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Provider Business Mailing Address
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Address Line | 50 MEMORIAL DR SUITE 110
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City | LEOMINSTER
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State | MA
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Zip | 01453-2238
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Country | US
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Telephone | 978-840-0055
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Fax | 978-840-0063
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RALPH E SPADA
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Credential | M.D.
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Telephone | 978-840-0055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 232981
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License Number State | MA
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