MEDICARE: PERSIVIA CARE, LLC

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
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1770169534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSIVIA CARE, LLC

Provider Business Mailing Address
First Line	:	4 MOUNT ROYAL AVE STE 400
Second Line	:
City	:	MARLBOROUGH
State	:	MA
Zip	:	01752-1961
Country	:	US
Telephone Number	:	978-856-4504
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 MOUNT ROYAL AVE STE 400
Second Line	:
City	:	MARLBOROUGH
State	:	MA
Zip	:	01752-1961
Country	:	US
Telephone Number	:	978-856-4504
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	AMMAR AFIF
Credential	:
Telephone Number	:	978-856-4504

Provider Enumeration Date	:	03/22/2021
Last Update Date	:	03/23/2021

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Directions to “PERSIVIA CARE, LLC ” Practice Location

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