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General NPI Number Information
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NPI Number | 1548066590
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Entity Type | Organization
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Legal Business Name | STARBOARD MEDICAL LLC
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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 | 603 SALEM ST STE 3
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City | WAKEFIELD
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State | MA
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Zip | 01880-1227
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Country | US
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Telephone | 781-245-6334
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Fax |
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Provider Business Mailing Address
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Address Line | 152 BELLEVUE RD
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City | WATERTOWN
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State | MA
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Zip | 02472-3375
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Country | US
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Telephone | 201-805-5595
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL FRIEDMAN
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Credential |
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Telephone | 201-805-5595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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