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NPI Code Detail

MEDICARE: TERRENCE ADAMS OMALLEY MD

MEDICARE: TERRENCE ADAMS OMALLEY MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician36969MA
2207RG0300XGeriatric Medicine (Internal Medicine) Physician36969MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1M08833OTHERMABCBS MA
2036969OTHERMATUFTS HEALTH PLAN
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083605612
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRENCE ADAMS OMALLEY MD
Provider Business Mailing Address
First Line : 70 FULTON ST
Second Line :
City : BOSTON
State : MA
Zip : 02109-1402
Country : US
Telephone Number : 617-724-4838
Fax Number : 617-726-9754
Provider Business Practice Location Address
First Line : 70 FULTON ST
Second Line :
City : BOSTON
State : MA
Zip : 02109-1402
Country : US
Telephone Number : 617-724-4838
Fax Number : 617-726-9754
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2005
Last Update Date : 05/19/2008

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