Provider Demographics
NPI:1629055538
Name:MELROSE INTERNAL MEDICINE ASSOC PC
Entity type:Organization
Organization Name:MELROSE INTERNAL MEDICINE ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTORNEY/BUSINESS
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:P
Authorized Official - Last Name:CRISS
Authorized Official - Suffix:
Authorized Official - Credentials:JD, LLM
Authorized Official - Phone:617-281-4119
Mailing Address - Street 1:50 ROWE ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3228
Mailing Address - Country:US
Mailing Address - Phone:781-979-3800
Mailing Address - Fax:781-662-2778
Practice Address - Street 1:50 ROWE ST
Practice Address - Street 2:SUITE 500
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3228
Practice Address - Country:US
Practice Address - Phone:781-979-3800
Practice Address - Fax:781-662-2778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA702274OtherTUFTS
MA9702156Medicaid
MACE3073OtherRAILROAD MEDICARE
M12445Medicare UPIN
MA9702156Medicaid