Provider Demographics
NPI:1407862048
Name:MEDICAL GROUP, INC., THE
Entity Type:Organization
Organization Name:MEDICAL GROUP, INC., THE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARRIET
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-927-4110
Mailing Address - Street 1:77 HERRICK ST
Mailing Address - Street 2:STE 101
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-3012
Mailing Address - Country:US
Mailing Address - Phone:978-927-4110
Mailing Address - Fax:978-232-7057
Practice Address - Street 1:77 HERRICK ST
Practice Address - Street 2:STE 101
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-3012
Practice Address - Country:US
Practice Address - Phone:978-927-4110
Practice Address - Fax:978-232-7057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9732152Medicaid
E3269OtherRAILROAD MDCR
MAM16435OtherBS
M20663Medicare ID - Type Unspecified