1164743092 NPI number — NEUROLOGY OF CENTRAL MASSACHUSETTS, PC

Table of content: (NPI 1164743092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164743092 NPI number — NEUROLOGY OF CENTRAL MASSACHUSETTS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROLOGY OF CENTRAL MASSACHUSETTS, PC
Provider Last Name:
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Provider Credential Text:
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Provider's Other Name Information

Provider Other Organization Name:
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NPI Number Information

NPI Number:
1164743092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 MEMORIAL DR
Provider Second Line Business Mailing Address:
SUITE 211
Provider Business Mailing Address City Name:
LEOMINSTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01453-2238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-466-1190
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 MEMORIAL DR
Provider Second Line Business Practice Location Address:
SUITE 211
Provider Business Practice Location Address City Name:
LEOMINSTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01453-2238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-466-1190
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MADDUKURI
Authorized Official First Name:
SRIREKHA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
978-466-1190

Provider Taxonomy Codes

  • Taxonomy code: 2084N0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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