Provider Demographics
NPI:1093170490
Name:UMASS MEMORIAL
Entity Type:Organization
Organization Name:UMASS MEMORIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENETIC COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL VECCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:LGC
Authorized Official - Phone:774-442-4223
Mailing Address - Street 1:55 LAKE AVE N
Mailing Address - Street 2:GENETICS, A3-105
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01655-0002
Mailing Address - Country:US
Mailing Address - Phone:774-442-4223
Mailing Address - Fax:774-442-3525
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:GENETICS, A3-105
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:774-442-4223
Practice Address - Fax:774-442-3525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAGC287282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital