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General NPI Number Information
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NPI Number | 1164314290
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Entity Type | Organization
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Legal Business Name | CENTRAL MASS MEDICAL GROUP
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Dates
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Enumeration Date | 07/15/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 5 LAUREL RIDGE LN
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City | SHREWSBURY
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State | MA
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Zip | 01545-6322
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Country | US
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Telephone | 215-908-2992
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Fax |
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Provider Business Mailing Address
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Address Line | 5 LAUREL RIDGE LN
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City | SHREWSBURY
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State | MA
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Zip | 01545-6322
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Country | US
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Telephone | 508-635-1386
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Fax | 877-828-1729
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Authorized Official
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Title or Position | CEO
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Name | PRAVEEN DEVINENI
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Credential |
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Telephone | 508-635-1386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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