Provider Demographics
NPI:1851464390
Name:MALDEN OB-GYN ASSOCIATES, INC.
Entity Type:Organization
Organization Name:MALDEN OB-GYN ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:MONTEIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-324-5006
Mailing Address - Street 1:405 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-6644
Mailing Address - Country:US
Mailing Address - Phone:781-324-5006
Mailing Address - Fax:781-324-5501
Practice Address - Street 1:405 PEARL ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-6644
Practice Address - Country:US
Practice Address - Phone:781-324-5006
Practice Address - Fax:781-324-5501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA57281207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA130371OtherHARVARD
MA9735950Medicaid
MA602829OtherTUFTS
MAM21677Medicare ID - Type Unspecified
MAA58725Medicare UPIN