Provider Demographics
NPI:1942905880
Name:MEDMIND LLC
Entity Type:Organization
Organization Name:MEDMIND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AEDOME
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRMA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:617-335-5096
Mailing Address - Street 1:185 DEVONSHIRE ST STE 500
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-1407
Mailing Address - Country:US
Mailing Address - Phone:617-335-5096
Mailing Address - Fax:
Practice Address - Street 1:185 DEVONSHIRE ST STE 500
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-1407
Practice Address - Country:US
Practice Address - Phone:617-335-5096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-31
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty