Provider Demographics
NPI:1518285535
Name:RALPH E TALBOT, MD PC
Entity Type:Organization
Organization Name:RALPH E TALBOT, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:TALBOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-381-0555
Mailing Address - Street 1:391 BROADWAY
Mailing Address - Street 2:SUITE 304
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-3470
Mailing Address - Country:US
Mailing Address - Phone:617-381-0555
Mailing Address - Fax:949-955-7321
Practice Address - Street 1:391 BROADWAY
Practice Address - Street 2:SUITE 304
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-3470
Practice Address - Country:US
Practice Address - Phone:617-381-0555
Practice Address - Fax:949-955-7321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA441052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3060624Medicaid
MA3060624Medicaid