1952309783 NPI number — METROWEST INTERNAL MEDICINE, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952309783 NPI number — METROWEST INTERNAL MEDICINE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METROWEST INTERNAL MEDICINE, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952309783
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
340 MAIN ST
Provider Second Line Business Mailing Address:
STE. 670
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01608-1604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-754-3566
Provider Business Mailing Address Fax Number:
508-438-6368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
61 LINCOLN ST
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
FRAMINGHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01702-8264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-879-0077
Provider Business Practice Location Address Fax Number:
508-875-1005
Provider Enumeration Date:
07/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ESTRIN
Authorized Official First Name:
MARINA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
508-879-0077

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9715690 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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