SOUTHBORO MEDICAL GROUP, INC (NPI# 1164834750) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164834750 |
| Entity Type | Organization |
| Organization Name | SOUTHBORO MEDICAL GROUP, INC |
| Practice Address |
24 Newton St Southborough MA 01772-1215 |
| Practice Telephone | 5084815500 |
| Practice Fax Number | 5084603025 |
| Mailing Telephone | 5084815500 |
| Mailing Fax Number | 5084603025 |
| Enumeration Date | 2014-05-30 |
| Last Update Date | 2014-05-30 |
| Authorized Official Name | HEATHER LABOSSIERE (CREDENTIALING SPECIALIST) |
| Authorized Official Telephone | 5084603297 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | Other Service Providers |
| Street Address |
24 NEWTON ST |
| City | SOUTHBOROUGH |
| State | MA |
| Zip Code | 01772-1215 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922094788 | Mark Finno, Md PC | Physical Medicine & Rehabilitation | 24 Newton St, Southborough, MA 01772-1215 | 2005-09-26 |
| 1649881699 | Jeremy Kw Spiewak | Pharmacist | 24 Newton St, Southborough, MA 01772-1215 | 2020-08-13 |
| 1437794716 | Reliant Medical Group, Inc | Optometrist | 24 Newton St, Southborough, MA 01772-1215 | 2019-11-11 |
| 1427516004 | Fnu Jomymerlythomas | Physical Therapist | 24 Newton St, Southborough, MA 01772-1215 | 2019-03-04 |
| 1629558960 | Amanda N Griffin | Nurse Practitioner | 24 Newton St, Southborough, MA 01772-1215 | 2018-08-16 |
| 1700322674 | Rosalind Gendreau | Registered Nurse | 24 Newton St, Southborough, MA 01772-1215 | 2017-01-16 |
| 1932584950 | Christine Ditullio | Nurse Practitioner | 24 Newton St, Southborough, MA 01772-1215 | 2015-07-21 |
| 1891175113 | Elizabeth Ann Minevich | Internal Medicine | 24 Newton St, Southborough, MA 01772-1215 | 2015-06-02 |
| 1588096754 | Shannon Leah Devlin | Registered Nurse | 24 Newton St, Southborough, MA 01772-1215 | 2013-07-30 |
| 1407296106 | Sarah Loy Gifford | Registered Nurse | 24 Newton St, Southborough, MA 01772-1215 | 2013-06-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043854391 | Hiral Patel | Pharmacist | 150 Northnoro Road, Suite 4, Southborough, MA 01772 | 2019-10-30 |
| 1588188544 | Jennifer Foran | Behavior Technician | 33 Turnkpike Road, Southborough, MA 01772 | 2017-08-01 |
| 1588184402 | Lise Mary Gallo | Behavioral Analyst | 16 Clifford St, Southborough, MA 01772 | 2017-06-21 |
| 1437508322 | Kristen Lomker | Pharmacist | 155 Northborough Rd, Southboro, MA 01772 | 2016-06-10 |
| 1679841829 | Scott Adam Canter | Acupuncturist | 64 William Onthank Lane, Southborough, MA 01772 | 2011-12-02 |
| 1396966206 | Umer Sayeed Shah | Surgery | 2 Parkcentral Drive Suite 210, Avc / Acc, Southborough, MA 01772 | 2007-05-01 |
| 1982636411 | Armineh Mirzabegian | Internal Medicine | Southboro Medical Group, 24 Newton Street, Southboro, MA 01772 | 2006-07-07 |
| 1336197508 | Lisa M Hassler | Pediatrics | 24 Newton Street, Southboro Medical Group, Southboro, MA 01772 | 2006-05-04 |
| 1295714640 | Robin K Morgan | Physical Therapist | 28 Newton St, Southborough, MA 01772 | 2006-01-13 |
| 1528562998 | Emily Marie Bagley | Student in an Organized Health Care Education/Training Program | 33 Turnpike Rd, Southborough, MA 01772 | 2018-03-21 |
| Find all providers in zip 01772 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689275760 | Heather Audra Wickham | Specialist | 19 Lukes Way, Plymouth, MA 02360-4717 | 2020-11-04 |
| 1811595440 | Elite Upper Extremity and Plastic Surgery, Pllc | Specialist | 123 Summer St Ste 550, Worcester, MA 01608-1216 | 2020-10-15 |
| 1285272559 | Michael Anthony Mandella | Specialist | 615 Reservoir Rd, Lunenburg, MA 01462-1540 | 2019-12-17 |
| 1003372996 | Pic A Nit LLC | Specialist | 111 Worcester Street, North Grafton, MA 01536 | 2019-02-15 |
| 1427513738 | Arlene L Casassa | Specialist | 271 Pond St, Hopkinton, MA 01748-1509 | 2019-01-31 |
| 1851881767 | Cheryl Ann Borden | Specialist | 51 Country Club Way, Ipswich, MA 01938-3000 | 2018-05-16 |
| 1518469089 | Kathleen L Golemon | Specialist | 100 Cummings Center Suite 158-d, Beverly, MA 01915 | 2018-03-01 |
| 1114426988 | Louise Berit Homstead | Specialist | 108 N Main St Ste A, Sunderland, MA 01375-9502 | 2018-02-07 |
| 1356859425 | Tanya Elaine Lachowicz | Specialist | 19 Agassiz St Apt 1, Cambridge, MA 02140-2826 | 2018-01-11 |
| 1083126338 | Kailash Nagrath | Specialist | 33 Sequattom Road, Harwich, MA 02645 | 2017-10-26 |
| Find all providers with the same taxonomy | ||||
| City | SOUTHBOROUGH |
| Zip Code | 01772 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.