Provider Demographics
NPI:1891709309
Name:DAVID MENON CORPORATION
Entity Type:Organization
Organization Name:DAVID MENON CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MENON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-625-9992
Mailing Address - Street 1:PO BOX 201
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-0004
Mailing Address - Country:US
Mailing Address - Phone:617-625-9992
Mailing Address - Fax:
Practice Address - Street 1:33 BOW ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-2937
Practice Address - Country:US
Practice Address - Phone:617-625-9992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM18125OtherBCBS
MA694457OtherTUFTS
MA9716599Medicaid
MA694457OtherTUFTS