Provider Demographics
NPI:1528007846
Name:CARITAS MEDICAL GROUP INC
Entity Type:Organization
Organization Name:CARITAS MEDICAL GROUP INC
Other - Org Name:CARITAS EMERGENCY PHYSICIANS GROUP GSAM
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF PHYSICIAN REVENUE
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:617-562-5338
Mailing Address - Street 1:736 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2907
Mailing Address - Country:US
Mailing Address - Phone:617-789-3212
Mailing Address - Fax:
Practice Address - Street 1:235 N PEARL ST
Practice Address - Street 2:EMERGENCY PHYSICIAN GROUP
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1794
Practice Address - Country:US
Practice Address - Phone:508-427-3034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2008-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000030534OtherBMC
M19082OtherBLUE SHIELD
MAM21741Medicare PIN