Provider Demographics
NPI:1518938109
Name:DR MARY P. MEDWAR PC
Entity Type:Organization
Organization Name:DR MARY P. MEDWAR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR MARY MEDWAR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:P
Authorized Official - Last Name:MEDWAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-324-2330
Mailing Address - Street 1:599 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-3920
Mailing Address - Country:US
Mailing Address - Phone:718-324-2330
Mailing Address - Fax:781-324-6836
Practice Address - Street 1:599 MAIN ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-3920
Practice Address - Country:US
Practice Address - Phone:718-324-2330
Practice Address - Fax:781-324-6836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA11045111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2193032OtherAETNA
B21147501OtherCIGNA
350187OtherHARVARD PILGRIM
001045OtherTUFTS
4440044OtherUNITED HEALTH
MAY35729OtherBLUE CROSS
MAY35729Medicare ID - Type Unspecified
MAY35729OtherBLUE CROSS