Provider Demographics
NPI:1972562320
Name:MELROSE SURGICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:MELROSE SURGICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:G
Authorized Official - Last Name:SHERNOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-979-6500
Mailing Address - Street 1:50 ROWE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3201
Mailing Address - Country:US
Mailing Address - Phone:781-979-6500
Mailing Address - Fax:781-665-3834
Practice Address - Street 1:50 ROWE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3201
Practice Address - Country:US
Practice Address - Phone:781-979-6500
Practice Address - Fax:781-665-3834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9779779Medicaid
MAM20251Medicare ID - Type Unspecified