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General NPI Number Information
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NPI Number | 1922283076
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Entity Type | Organization
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Legal Business Name | ACCESS MD
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Dates
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Enumeration Date | 01/08/2008
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Last Update Date | 07/30/2008
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Provider Practice Location Address
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Address Line | 873 WORCESTER ST
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City | WELLESLEY
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State | MA
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Zip | 02482-3714
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Country | US
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Telephone | 781-416-5200
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Fax | 781-416-0956
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Provider Business Mailing Address
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Address Line | 873 WORCESTER ST
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City | WELLESLEY
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State | MA
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Zip | 02482-3714
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Country | US
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Telephone | 781-416-5200
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Fax | 781-416-0956
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Authorized Official
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Title or Position | OWNER
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Name | RICHARD S GOLDMAN
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Credential | MD
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Telephone | 781-416-5200
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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 | 56153
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License Number State | MA
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