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General NPI Number Information
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NPI Number | 1134925241
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Entity Type | Organization
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Legal Business Name | AMERICAN WELL MEDICAL GROUP CA, PC
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Dates
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Enumeration Date | 02/20/2025
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 75 STATE ST STE 26
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City | BOSTON
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State | MA
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Zip | 02109-1827
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Country | US
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Telephone | 617-204-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 75 STATE ST STE 26
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City | BOSTON
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State | MA
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Zip | 02109-1827
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CYNTHIA HORNER
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Credential | MD
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Telephone | 703-505-6002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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