Provider Demographics
NPI:1649422791
Name:METRO MEDICAL ASSOCIATES ,PC
Entity Type:Organization
Organization Name:METRO MEDICAL ASSOCIATES ,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KUNLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FAJANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-753-4151
Mailing Address - Street 1:390 MAIN ST
Mailing Address - Street 2:SUITE 509
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-2583
Mailing Address - Country:US
Mailing Address - Phone:508-753-4151
Mailing Address - Fax:
Practice Address - Street 1:390 MAIN ST
Practice Address - Street 2:SUITE 509
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-2583
Practice Address - Country:US
Practice Address - Phone:508-753-4151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73428207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty