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General NPI Number Information
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NPI Number | 1790730539
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Entity Type | Organization
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Legal Business Name | MELROSE WAKEFIELD EMERGENCY PHYSICIANS, INC.
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 02/02/2012
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Provider Practice Location Address
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Address Line | 585 LEBANON ST
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City | MELROSE
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State | MA
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Zip | 02176-3225
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Country | US
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Telephone | 781-280-1736
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Fax |
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Provider Business Mailing Address
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Address Line | 8 OAK PARK DR
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City | BEDFORD
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State | MA
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Zip | 01730-1414
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Country | US
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Telephone | 781-280-1736
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Fax | 781-276-6404
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELIJAH BERG
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Credential | MD
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Telephone | 781-280-1500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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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