Provider Demographics
NPI:1326582206
Name:TELLINMEDICINE LLC
Entity Type:Organization
Organization Name:TELLINMEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASPER
Authorized Official - Middle Name:I
Authorized Official - Last Name:NGMONBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-513-1446
Mailing Address - Street 1:380 ELM ST STE 1
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-3314
Mailing Address - Country:US
Mailing Address - Phone:774-643-6261
Mailing Address - Fax:774-643-6358
Practice Address - Street 1:380 ELM STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760
Practice Address - Country:US
Practice Address - Phone:508-682-1686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA245843207R00000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty