Provider Demographics
NPI:1093797920
Name:NORMAN, MAUREEN E (DO)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:E
Last Name:NORMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 MILL ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-4700
Mailing Address - Country:US
Mailing Address - Phone:781-648-7707
Mailing Address - Fax:
Practice Address - Street 1:50 MILL ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4700
Practice Address - Country:US
Practice Address - Phone:781-648-7707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA58301207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3030423Medicaid
MAB98122Medicare UPIN
MAJ06996Medicare ID - Type Unspecified