Provider Demographics
NPI:1053455907
Name:NORTHEAST MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:NORTHEAST MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAYEEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-388-6900
Mailing Address - Street 1:5 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-2835
Mailing Address - Country:US
Mailing Address - Phone:978-762-4888
Mailing Address - Fax:888-541-7880
Practice Address - Street 1:5 BEACON ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-2835
Practice Address - Country:US
Practice Address - Phone:978-388-6900
Practice Address - Fax:888-541-7880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110067579AMedicaid
MAM21000Medicare PIN