Provider Demographics
NPI:1497874994
Name:MELROSE MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:MELROSE MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:LATTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-662-7037
Mailing Address - Street 1:792 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-2710
Mailing Address - Country:US
Mailing Address - Phone:781-662-7037
Mailing Address - Fax:781-662-6164
Practice Address - Street 1:792 MAIN ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-2710
Practice Address - Country:US
Practice Address - Phone:781-662-7037
Practice Address - Fax:781-662-6164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA35729174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM14671Medicare ID - Type UnspecifiedGROUP NUMBER