Provider Demographics
NPI:1518903327
Name:MALDEN PRIMARY CARE, PC
Entity Type:Organization
Organization Name:MALDEN PRIMARY CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HOCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-322-9670
Mailing Address - Street 1:380 PLEASANT ST
Mailing Address - Street 2:SUITE 13
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-8123
Mailing Address - Country:US
Mailing Address - Phone:781-322-3005
Mailing Address - Fax:781-322-1394
Practice Address - Street 1:380 PLEASANT ST
Practice Address - Street 2:SUITE 13
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-8123
Practice Address - Country:US
Practice Address - Phone:781-322-3005
Practice Address - Fax:781-322-1394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA37725207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9736000Medicaid
MA9736000Medicaid