Provider Demographics
NPI:1801398953
Name:GENERA HEALTH DIRECT LLC
Entity Type:Organization
Organization Name:GENERA HEALTH DIRECT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:C
Authorized Official - Last Name:CASTRO-ZARRAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-322-9949
Mailing Address - Street 1:46 SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM HEIGHTS
Mailing Address - State:MA
Mailing Address - Zip Code:02494-1452
Mailing Address - Country:US
Mailing Address - Phone:773-322-9949
Mailing Address - Fax:773-897-5905
Practice Address - Street 1:105 CHESTNUT ST STE 35
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2520
Practice Address - Country:US
Practice Address - Phone:508-563-3003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-05
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251722207Q00000X
MA157184207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty