Provider Demographics
NPI:1346641503
Name:FRANK TWAROG MD PHD AND CURTIS MOODY MD LLP
Entity Type:Organization
Organization Name:FRANK TWAROG MD PHD AND CURTIS MOODY MD LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-369-3567
Mailing Address - Street 1:1 BROOKLINE PL
Mailing Address - Street 2:STE 424
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7224
Mailing Address - Country:US
Mailing Address - Phone:617-735-8750
Mailing Address - Fax:617-735-8752
Practice Address - Street 1:1 BROOKLINE PL
Practice Address - Street 2:STE 424
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7224
Practice Address - Country:US
Practice Address - Phone:617-735-8750
Practice Address - Fax:617-735-8752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34521207K00000X
MA57637207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM20418OtherMEDICARE GROUP PTAN