Provider Demographics
NPI:1013034768
Name:ALAN N. ERTEL, MD, PC
Entity Type:Organization
Organization Name:ALAN N. ERTEL, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:ERTEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-646-7730
Mailing Address - Street 1:22 MILL STREET
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-4744
Mailing Address - Country:US
Mailing Address - Phone:781-646-7730
Mailing Address - Fax:781-646-2950
Practice Address - Street 1:22 MILL ST
Practice Address - Street 2:SUITE 302
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4784
Practice Address - Country:US
Practice Address - Phone:781-646-7730
Practice Address - Fax:781-646-2950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA46628174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2089874Medicaid
MAA56182Medicare UPIN
MAJ010801Medicare ID - Type Unspecified