Provider Demographics
NPI:1063647683
Name:NEW ENGLAND PAIN ASSOCIATES, PC
Entity Type:Organization
Organization Name:NEW ENGLAND PAIN ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FATHALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASHALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-232-7464
Mailing Address - Street 1:10 CONVERSE PL
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-2713
Mailing Address - Country:US
Mailing Address - Phone:781-729-0500
Mailing Address - Fax:781-729-0581
Practice Address - Street 1:1 PEARL ST
Practice Address - Street 2:SUITE 2300
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2864
Practice Address - Country:US
Practice Address - Phone:508-232-7464
Practice Address - Fax:508-232-7484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9751921Medicaid
MA9751921Medicaid