Provider Demographics
NPI:1043365950
Name:CLINTON MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:CLINTON MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KAVITA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:9789-368-3707
Mailing Address - Street 1:PO BOX 772
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01510-6772
Mailing Address - Country:US
Mailing Address - Phone:978-368-3707
Mailing Address - Fax:
Practice Address - Street 1:201 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MA
Practice Address - Zip Code:01510-1037
Practice Address - Country:US
Practice Address - Phone:978-368-3707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150431207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9707701Medicaid
MAM21039Medicare ID - Type Unspecified