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General NPI Number Information
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NPI Number | 1760445373
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Entity Type | Organization
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Legal Business Name | UMASS MEMORIAL MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 04/07/2006
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 55 LAKE AVE N
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City | WORCESTER
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State | MA
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Zip | 01655-0002
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Country | US
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Telephone | 508-334-1000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 415348 ATTN: PROVIDER ENROLLMENT DEPARTMENT
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City | BOSTON
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State | MA
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Zip | 02241-5348
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Country | US
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Telephone | 508-334-8015
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Fax | 508-334-8105
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Authorized Official
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Title or Position | SVP/COO
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Name | MS. MAUREEN BRESEE-FERREIRA
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Credential |
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Telephone | 774-442-1520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #10
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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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Taxonomy #11
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #13
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Taxonomy Code | 204F00000X
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Taxonomy Name | Transplant Surgery Physician
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License Number |
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License Number State |
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Taxonomy #14
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #15
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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