Provider Demographics
NPI:1235494865
Name:MADDIES MOBILE HEALTHCARE
Entity Type:Organization
Organization Name:MADDIES MOBILE HEALTHCARE
Other - Org Name:MADDIES MOBILE HEALTHCARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:FIORINO
Authorized Official - Suffix:
Authorized Official - Credentials:RMA /CARDIO PHLEBOTO
Authorized Official - Phone:781-885-7338
Mailing Address - Street 1:76 NEWCOMB AVE
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-2654
Mailing Address - Country:US
Mailing Address - Phone:781-885-7338
Mailing Address - Fax:
Practice Address - Street 1:76 NEWCOMB AVE
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-2654
Practice Address - Country:US
Practice Address - Phone:781-885-7338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1714303246RP1900X
MAS10040837347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty
No347C00000XTransportation ServicesPrivate VehicleGroup - Multi-Specialty