Provider Demographics
NPI:1356871172
Name:MILFORD REGIONAL PHYSICIAN GROUP, INC.
Entity type:Organization
Organization Name:MILFORD REGIONAL PHYSICIAN GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:J
Authorized Official - Last Name:CIARAMICOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-473-1480
Mailing Address - Street 1:9 INDUSTRIAL RD STE 5
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3736
Mailing Address - Country:US
Mailing Address - Phone:508-473-1480
Mailing Address - Fax:508-473-1210
Practice Address - Street 1:129 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757
Practice Address - Country:US
Practice Address - Phone:774-462-3339
Practice Address - Fax:508-381-0204
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILFORD REGIONAL PHYSICIAN GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-14
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110082161Medicaid