Provider Demographics
NPI:1558426544
Name:CITY OF MARLBOROUGH
Entity Type:Organization
Organization Name:CITY OF MARLBOROUGH
Other - Org Name:MARLBOROUGH BOARD OF HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR - MARLBOROUGH BOARD OF HEA
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED SANITARIA
Authorized Official - Phone:508-460-3751
Mailing Address - Street 1:255 MAIN ST
Mailing Address - Street 2:ROOM 101
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-2536
Mailing Address - Country:US
Mailing Address - Phone:508-460-3751
Mailing Address - Fax:508-460-3638
Practice Address - Street 1:255 MAIN ST
Practice Address - Street 2:ROOM 101
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-5505
Practice Address - Country:US
Practice Address - Phone:508-460-3751
Practice Address - Fax:508-460-3638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY11009Medicare PIN