Provider Demographics
NPI:1073000261
Name:DEMIAN GRECE MOUSAD DBA WORCESTER PAIN MANAGEMENT
Entity Type:Organization
Organization Name:DEMIAN GRECE MOUSAD DBA WORCESTER PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEMIAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MOUSAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-904-9036
Mailing Address - Street 1:1 CARLISLE TER
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-2060
Mailing Address - Country:US
Mailing Address - Phone:508-904-9026
Mailing Address - Fax:
Practice Address - Street 1:116 BELMONT ST RM 34
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605
Practice Address - Country:US
Practice Address - Phone:508-904-9026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-13
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty