Provider Demographics
NPI:1710091319
Name:THE HUROWITZ MEDICAL GROUP
Entity Type:Organization
Organization Name:THE HUROWITZ MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:I
Authorized Official - Last Name:HUROWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-753-8800
Mailing Address - Street 1:255 PARK AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1985
Mailing Address - Country:US
Mailing Address - Phone:508-753-8800
Mailing Address - Fax:508-753-0116
Practice Address - Street 1:255 PARK AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1953
Practice Address - Country:US
Practice Address - Phone:508-753-8800
Practice Address - Fax:508-753-0116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54669207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM15839OtherBLUECROSS BLUESHIELD
MAM15839Medicare ID - Type Unspecified