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General NPI Number Information
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NPI Number | 1740551589
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Entity Type | Organization
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Legal Business Name | MASSACHUSETTS WELLNESS GROUP
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Dates
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Enumeration Date | 01/25/2012
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Last Update Date | 01/25/2012
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Provider Practice Location Address
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Address Line | 360 BROCKTON AVE SUITE 203
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City | ABINGTON
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State | MA
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Zip | 02351-2186
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Country | US
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Telephone | 781-982-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 360 BROCKTON AVE SUITE 203
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City | ABINGTON
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State | MA
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Zip | 02351-2186
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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 | MICHAEL CAMPANALE
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Credential |
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Telephone | 617-947-1666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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