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General NPI Number Information
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NPI Number | 1386700417
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Entity Type | Organization
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Legal Business Name | MEDFORD OBGYN ASSOCIATES INC
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Dates
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Enumeration Date | 01/01/2007
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 390 HIGHLAND AVE
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City | WINCHESTER
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State | MA
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Zip | 01890-3147
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Country | US
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Telephone | 781-729-9456
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Fax | 781-729-9456
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Provider Business Mailing Address
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Address Line | 390 HIGHLAND AVE
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City | WINCHESTER
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State | MA
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Zip | 01890-3147
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Country | US
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Telephone | 781-729-9456
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Fax | 781-729-9456
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Authorized Official
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Title or Position | PLAN ADMINISTRATOR
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Name | DR. ROSARIO A. SCANDURA
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Credential | M.D.
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Telephone | 781-729-9456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 24674
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License Number State | MA
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