Provider Demographics
NPI:1447584859
Name:PERSONALIZED PREVENTIVE MEDICINE INC
Entity Type:Organization
Organization Name:PERSONALIZED PREVENTIVE MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D., F.A.C.C
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:DELANY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-698-0715
Mailing Address - Street 1:2 REEDSDALE RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3324
Mailing Address - Country:US
Mailing Address - Phone:617-698-0715
Mailing Address - Fax:617-698-7559
Practice Address - Street 1:2 REEDSDALE RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3324
Practice Address - Country:US
Practice Address - Phone:617-698-0715
Practice Address - Fax:617-698-7559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44038261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MABB97278OtherBB UPIN
MAC15079OtherBCBS
MAM14950Medicare UPIN