MEDICARE: RELIANT MEDICAL GROUP

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	152W00000X	Optometrist

General Provider Information

NPI Number	:	1831442581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RELIANT MEDICAL GROUP

Provider Business Mailing Address
First Line	:	630 PLANTATION ST
Second Line	:	WOT 12TH FL, ATTN: MEDICAL STAFF SERVICES
City	:	WORCESTER
State	:	MA
Zip	:	01605-2038
Country	:	US
Telephone Number	:	508-368-5424
Fax Number	:	508-368-5530

Provider Business Practice Location Address
First Line	:	115 CEDAR ST
Second Line	:	NORTH BLDG
City	:	MILFORD
State	:	MA
Zip	:	01757-5118
Country	:	US
Telephone Number	:	508-634-3100
Fax Number	:

Authorized Official
Title or Position	:	CHIEF MEDICAL OFFICER
Name	:	DR. ROBIN RICHMAN
Credential	:	MD
Telephone Number	:	508-852-0600

Provider Enumeration Date	:	10/18/2012
Last Update Date	:	10/18/2012

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