Provider Demographics
NPI:1093103087
Name:MINDFUL MEDICAL CARE P.C.
Entity Type:Organization
Organization Name:MINDFUL MEDICAL CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AZIZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-759-9413
Mailing Address - Street 1:100 TEATICKET HWY
Mailing Address - Street 2:
Mailing Address - City:TEATICKET
Mailing Address - State:MA
Mailing Address - Zip Code:02536-5678
Mailing Address - Country:US
Mailing Address - Phone:603-759-9413
Mailing Address - Fax:
Practice Address - Street 1:100 TEATICKET HWY
Practice Address - Street 2:
Practice Address - City:TEATICKET
Practice Address - State:MA
Practice Address - Zip Code:02536-5678
Practice Address - Country:US
Practice Address - Phone:603-759-9413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-30
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251913208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110102060AMedicaid