Provider Demographics
NPI:1831349984
Name:NEW ENGLAND PAIN ASSOCIATES
Entity type:Organization
Organization Name:NEW ENGLAND PAIN ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FATHALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASHALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-490-2130
Mailing Address - Street 1:42 HEMINGWAY DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-2224
Mailing Address - Country:US
Mailing Address - Phone:401-490-2130
Mailing Address - Fax:401-435-2483
Practice Address - Street 1:10 CONVERSE PL
Practice Address - Street 2:4TH FLOOR
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-2713
Practice Address - Country:US
Practice Address - Phone:781-729-0500
Practice Address - Fax:781-729-0581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207LC0200X, 2081P2900X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM18990OtherBCBS
MA9751921Medicaid
MA9751921Medicaid