Provider Demographics
NPI:1154657997
Name:SEASONS MEDICAL GROUP INC
Entity Type:Organization
Organization Name:SEASONS MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:GELMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-803-0717
Mailing Address - Street 1:15 MAIN ST
Mailing Address - Street 2:#238
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4403
Mailing Address - Country:US
Mailing Address - Phone:800-803-0717
Mailing Address - Fax:
Practice Address - Street 1:15 MAIN ST
Practice Address - Street 2:#238
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4403
Practice Address - Country:US
Practice Address - Phone:800-803-0717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty