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	:	1871846428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RELIANT MEDICAL GROUP

Provider Business Mailing Address
First Line	:	5 NEPONSET ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01606-2714
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	64 BOYDEN RD
Second Line	:
City	:	HOLDEN
State	:	MA
Zip	:	01520-2570
Country	:	US
Telephone Number	:	508-856-9599
Fax Number	:	508-829-4988

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	TAREK ELSAWY
Credential	:	MD
Telephone Number	:	508-852-0600

Provider Enumeration Date	:	10/19/2012
Last Update Date	:	11/11/2019

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Directions to “RELIANT MEDICAL GROUP ” Practice Location

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