Provider Demographics
NPI:1669695839
Name:ACKIL MEDICAL ASSOCIATES, INC
Entity type:Organization
Organization Name:ACKIL MEDICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ACKIL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:617-327-3450
Mailing Address - Street 1:1 CORINTH ST
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-3087
Mailing Address - Country:US
Mailing Address - Phone:617-327-3450
Mailing Address - Fax:617-327-0573
Practice Address - Street 1:1 CORINTH ST
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-3087
Practice Address - Country:US
Practice Address - Phone:617-327-3450
Practice Address - Fax:617-327-0573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA30313207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9700579Medicaid
MA9700579Medicaid
MAA65833Medicare UPIN