Provider Demographics
NPI:1053510180
Name:SUN MEDICAL CLINIC, PC
Entity Type:Organization
Organization Name:SUN MEDICAL CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:SPADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-840-0055
Mailing Address - Street 1:50 MEMORIAL DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-2238
Mailing Address - Country:US
Mailing Address - Phone:978-840-0055
Mailing Address - Fax:978-840-0063
Practice Address - Street 1:50 MEMORIAL DR
Practice Address - Street 2:SUITE 110
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-2238
Practice Address - Country:US
Practice Address - Phone:978-840-0055
Practice Address - Fax:978-840-0063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA232981261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service