Provider Demographics
NPI:1689316283
Name:NOVELLA MEDICINE SERVICES OF MASSACHUSETTS, PLLC
Entity Type:Organization
Organization Name:NOVELLA MEDICINE SERVICES OF MASSACHUSETTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:AMORY
Authorized Official - Last Name:THORNDIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-724-5916
Mailing Address - Street 1:360 US HIGHWAY 1 BYP UNIT 102
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7105
Mailing Address - Country:US
Mailing Address - Phone:781-724-5916
Mailing Address - Fax:
Practice Address - Street 1:416 BELMONT ST STE 206
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-1086
Practice Address - Country:US
Practice Address - Phone:603-836-9869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-13
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty