Provider Demographics
NPI:1467568899
Name:MEDICAL GROUP INC
Entity Type:Organization
Organization Name:MEDICAL GROUP INC
Other - Org Name:CARDIOPULMONARY LAB
Other - Org Type:Doing Business As
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:STITE 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:SUITE 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:2006-08-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2474291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0804436Medicaid
M16434OtherBLUE SHIELD
020769Medicare PIN