Provider Demographics
NPI:1457669293
Name:PLYMOUTH MEDAL GROUP INC
Entity Type:Organization
Organization Name:PLYMOUTH MEDAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-330-9116
Mailing Address - Street 1:71 COMMERCIAL ST
Mailing Address - Street 2:STE 307
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-1320
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:71 COMMERCIAL ST
Practice Address - Street 2:STE 307
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-1320
Practice Address - Country:US
Practice Address - Phone:774-330-9116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219192207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty